CN114615946A

CN114615946A - Signal coordinated delivery of laser therapy

Info

Publication number: CN114615946A
Application number: CN202080068270.XA
Authority: CN
Inventors: 谢尔盖·A·布克索夫; 布里安·M·塔尔博特; 库尔特·G·谢尔顿; 千田雅泰; 拉谢尔·D·施纳肯贝格
Original assignee: Gyrus ACMI Inc
Current assignee: Gyrus ACMI Inc
Priority date: 2019-08-05
Filing date: 2020-08-04
Publication date: 2022-06-10
Anticipated expiration: 2040-08-04
Also published as: US11980350B2; DE112020003155T5; JP2022543268A; CN118490349A; CN114206249B; CN114206249A; JP2022543267A; JP2024001214A; US20240023796A1; WO2021026158A1; US20240245289A1; US11819195B2; DE112020003714T5; US20210038064A1; JP7430778B2; JP2024050738A; CN114615946B; WO2021026167A1; US20210044079A1; JP7367177B2

Abstract

Systems, devices, and methods for using spectroscopic feedback to direct laser energy toward target tissue. An exemplary laser feedback control system includes a feedback analyzer for receiving a signal from a target tissue using a spectroscopy sensor, and a laser controller for determining whether the received signal is substantially equal to a first preset. In case the received signal satisfies a first preset, the laser controller may send a control signal to the laser system to change from a first state of the first laser system to a second state of the first laser system. The laser system may deliver laser energy to the target tissue via an optical fiber.

Description

Signal coordinated delivery of laser therapy

Priority declaration

This application claims priority to U.S. provisional patent application serial No. 62/882,837 filed on day 5, 8/2019, U.S. provisional patent application serial No. 62/894,226 filed on day 30, 8/2019, and U.S. provisional patent application serial No. 62/027,090 filed on day 19, 5/2020, the entire contents of which are incorporated herein by reference.

Technical Field

This document relates generally to endoscopic laser systems, and more particularly to systems and methods for controlling laser energy delivered to a target based on spectroscopic feedback.

Background

Endoscopes are commonly used to provide access to an internal location of a subject, thereby providing a physician with visual access. Endoscopes are typically inserted into a patient, transmit light to a target (e.g., a target anatomy or object) under examination, and collect light reflected from the object. The reflected light carries information about the object under examination. Some endoscopes include a working channel through which an operator may perform suction or delivery instruments such as brushes, biopsy needles, or forceps, or perform minimally invasive surgical procedures to remove unwanted tissue or foreign matter from the body of a patient.

Laser or plasma systems have been used to deliver surgical laser energy to various target treatment areas, such as soft or hard tissue. Examples of laser therapy include ablation, coagulation, vaporization, fragmentation, and the like. In lithotripsy applications, lasers have been used to break down stone structures in the kidney, gall bladder, ureters, and other stone-forming regions, or to ablate large stones into smaller fragments.

Disclosure of Invention

The present disclosure describes systems, devices, and methods for delivering laser energy to target tissue using spectroscopic feedback. An exemplary laser feedback control system includes a feedback analyzer for receiving a signal from a target tissue using a spectroscopy sensor, and a laser controller for determining whether the received signal is substantially equal to a first preset. In case the received signal satisfies a first preset, the laser controller may send a control signal to the laser system to change from a first state of the first laser system to a second state of the first laser system. The laser system may deliver laser energy to the target tissue via an optical fiber.

Example 1 is a laser feedback control system coupled to a first laser system configured to deliver laser energy directed to a target tissue. The laser feedback control system includes: a feedback analyzer for receiving a signal from the target tissue using the spectroscopic sensor, the signal comprising a first signal indicative of one or more spectroscopic properties of the target tissue; and a laser controller in operative communication with each of the feedback analyzer and the first laser system, the laser controller configured to: receiving a first signal from a feedback analyzer; determining whether the first signal is substantially equal to a first preset; and sending a first control signal to the first laser system to change from a first state of the first laser system to a second state of the first laser system if the first signal satisfies a first preset.

In example 2, the subject matter of example 1 optionally includes: wherein the laser controller is further configured to receive a second signal from the feedback analyzer, the second signal being different from the first signal.

In example 3, the subject matter of example 2 optionally includes: wherein the laser controller is further configured to: in the event that the second signal is substantially equal to a second preset, a second control signal is sent to the first laser system to change from the second state of the first laser system to the first state of the first laser system.

In example 4, the subject matter of any one or more of examples 2 to 3 optionally includes: wherein the laser feedback control system is configured to be connectable to a second laser system different from the first laser system.

In example 5, the subject matter of example 4 optionally includes: wherein the laser controller is configured to independently control the first laser system and the second laser system.

In example 6, the subject matter of example 5 optionally includes: wherein the laser controller is configured to send a third control signal to the second laser system to change from the first state of the second laser system to the second state of the second laser system if the second signal is substantially equal to a second preset.

In example 7, the subject matter of example 6 optionally includes: wherein the laser controller is configured to send a fourth control signal to the second laser system to change from the second state of the second laser system to the first state of the second laser system if the laser controller determines that the first signal is substantially equal to the first preset.

In example 8, the subject matter of example 7 optionally includes: wherein, in the event that the laser controller determines that the first signal satisfies a first preset, the laser controller is configured to: sending a first control signal to the first laser system to change the first laser system from a first state of the first laser system to a second state of the first laser system; and sending a fourth control signal to the second laser system to change the second laser system from the second state of the second laser system to the first state of the second laser system.

In example 9, the subject matter of example 8 can optionally include: wherein, in the event that the laser controller determines that the second signal satisfies a second preset, the laser controller is configured to: sending a second control signal to the first laser system to change the first laser system from the second state of the first laser system to the first state of the first laser system; and sending a third control signal to the second laser system to change the second laser system from the first state of the second laser system to the second state of the second laser system.

In example 10, the subject matter of any one or more of examples 1 to 9 optionally includes: wherein the spectroscopic sensor comprises at least one of: an imaging camera device; a Fourier Transform Infrared (FTIR) spectrometer; a Raman spectrometer; a UV-VIS reflectance spectrometer; or a fluorescence spectrometer.

In example 11, the subject matter of any one or more of examples 1 to 10 optionally includes: a signal detection fiber operably coupled to the spectroscopic sensor, the signal detection fiber configured to transmit a first signal from the target tissue to the spectroscopic sensor.

In example 12, the subject matter of any one or more of examples 1 to 11 optionally includes: wherein a spectroscopy sensor is in operable communication with the first optical fiber of the first laser system, the spectroscopy sensor configured to detect the first signal via the first optical fiber of the first laser system.

Example 13 is a laser therapy system, comprising: a first laser system, comprising: a first laser source, and a first optical fiber operably coupled to the first laser source, the first optical fiber configured to transmit energy from the first laser source to a target tissue; and a laser feedback control system coupled to the first laser system, the laser feedback control system comprising: a feedback analyzer for receiving a signal from a target tissue, the signal comprising a first signal indicative of one or more spectroscopic properties of the target tissue; and a laser controller in operative communication with each of the feedback analyzer and the first laser system, the laser controller configured to receive the first signal from the feedback analyzer to determine whether the first signal is substantially equal to a first preset, and to send a first control signal to the first laser system to change from a first state of the first laser system to a second state of the first laser system.

In example 14, the subject matter of example 13 can optionally include the second laser system comprising a second laser source in operable communication with the first optical fiber.

In example 15, the subject matter of example 14 can optionally include: wherein the first laser source is configured to produce a first laser output within a first wavelength range and the second laser source is configured to produce a second laser output within a second wavelength range different from the first wavelength range.

In example 16, the subject matter of example 15 can optionally include: wherein the first wavelength range corresponds to at least a portion of an absorption spectrum of the target tissue and the second wavelength range corresponds to at least a portion of an absorption spectrum of the carbonized tissue.

In example 17, the subject matter of any one or more of examples 14 to 16 optionally includes: wherein the second laser system is controllable by the laser controller such that upon receiving a control signal from the laser controller, the second laser system changes from a first state of the second laser system to a second state of the second laser system or from the second state of the second laser system to the first state of the second laser system.

In example 18, the subject matter of any one or more of examples 14 to 17 optionally includes: wherein the first state of each of the first and second laser systems corresponds to the generation of the first laser output by the first laser source and the second laser output by the second laser source, respectively.

In example 19, the subject matter of any one or more of examples 14 to 18 optionally includes: wherein the second state of each of the first and second laser systems corresponds to a state in which the first and second laser sources each produce no laser output.

Example 20 is a method of controlling a laser therapy system including a first laser system. The method comprises the following steps: receiving, using a feedback analyzer, a signal from a target tissue, the signal comprising a first signal indicative of one or more spectroscopic properties of the target tissue; determining, using the laser controller, whether the first signal is substantially equal to a first preset; and sending a first control signal to the first laser system to change from a first state of the first laser system to a second state of the first laser system if the first signal is substantially equal to a first preset.

In example 21, the subject matter of example 20 optionally includes: wherein the first signal indicates that the target tissue is carbonized by absorbing the first laser output from the first laser system.

In example 22, the subject matter of example 21 can optionally include: wherein the first state of the first laser system corresponds to a state when the first laser system generates the first laser output, and the second state of the first laser system corresponds to a state when the first laser system does not generate the first laser output.

In example 23, the subject matter of any one or more of examples 20 to 22 optionally includes: wherein the signal received by the feedback analyzer comprises a second signal different from the first signal.

This summary is an overview of some of the teachings of the present application and is not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details regarding the present subject matter are found in the detailed description and appended claims. Other aspects of the disclosure will be apparent to those skilled in the art upon reading and understanding the following detailed description and viewing the drawings that form a part hereof, and each aspect should not be considered in a limiting sense. The scope of the present disclosure is defined by the appended claims and their legal equivalents.

Drawings

Various embodiments are shown by way of example in the figures of the drawings. These embodiments are illustrative and are not intended to be exhaustive or exclusive embodiments of the present subject matter.

Fig. 1 shows a schematic diagram of an exemplary laser treatment system including a laser feedback control system.

Fig. 2A to 2B show examples of absorption spectra of different types of tissues including hemoglobin (Hb) and oxygenated hemoglobin (HbO 2).

Fig. 3A to 3C show examples of absorption spectra of different types of tissues including normal tissue and carbonized tissue, Hb, HbO2, and melanin.

Fig. 4 is a graph showing the penetration depth of the laser output.

Fig. 5 is a block diagram illustrating a laser feedback control system for providing laser output.

Fig. 6-7 are flow charts illustrating examples of algorithms for controlling one or more laser systems based on feedback generated by a laser feedback control system.

Fig. 8 shows a timing diagram for an exemplary dual laser system that provides tissue ablation and coagulation using two optical wavelengths.

Fig. 9A to 9B show an example of an endoscope into which a laser optical fiber is inserted.

Fig. 10A-10B illustrate examples of feedback controlled laser treatment systems.

Fig. 11A to 11B are diagrams illustrating an example of an endoscope system for recognizing a target using a diagnostic beam such as a laser beam.

Fig. 12 and 13A to 13B are diagrams showing reflection spectra for identifying a target type, for example, for identifying components of different types of kidney stones.

Fig. 14 to 15 show the light peaks corresponding to different parts of the UV wavelength and the reflection spectra of several types of stone blocks in fig. 13A to 13B.

Fig. 16A-16B show examples of reflectance spectra captured on a UV-VIS spectrometer from various soft and hard tissue components.

Fig. 16C shows an example of FTIR spectra of typical stone components.

Fig. 16D shows an example of FTIR spectra of some soft and hard tissue components.

Fig. 17-18 show schematic views of a laser treatment system.

Fig. 19A-19B illustrate examples of combined laser pulse trains generated using multiple (e.g., N) laser pulse trains.

Fig. 20 shows a schematic diagram of an exemplary spectroscopy system with spectral feedback.

Fig. 21A to 21D show an example of an endoscope laser system having a multi-fiber configuration.

Fig. 22 is a block diagram illustrating an example of a multi-fiber system as used in a spectroscopy fiber delivery system.

Fig. 23A-23B show examples of a multi-fiber accessory with a source light input and a spectroscopic feedback signal.

Fig. 24A-24D are diagrams illustrating an exemplary method of calculating a distance between a distal end of a laser delivery system (e.g., an optical fiber) and a target.

Fig. 25A-25B illustrate the effect of the distance between the tissue and the distal end of the spectroscopic probe on the spectrum of reflected light from the target.

Fig. 26 shows an example of an endoscope system for identifying a target using a diagnostic beam such as a laser beam.

Fig. 27 shows a diagram of laser pulse sequences with different pulse energies or power levels for laser treatment of a target tissue or stone structure.

Fig. 28 is a block diagram illustrating an example machine on which any one or more of the techniques (e.g., methods) discussed herein may be performed.

Detailed Description

Systems, devices, and methods for delivering laser energy to target tissue using spectroscopic feedback are described herein. An exemplary laser feedback control system includes a feedback analyzer for receiving a signal from a target tissue using a spectroscopy sensor, and a laser controller for determining whether the received signal is substantially equal to a first preset. In case the received signal satisfies a first preset, the laser controller may send a control signal to the laser system to change from a first state of the first laser system to a second state of the first laser system. The laser system may deliver laser energy to the target tissue via an optical fiber.

In endoscopic laser therapy, it is desirable to identify different tissues, apply laser energy only to the targeted treatment structure (e.g., cancerous tissue or a particular stone type), and avoid or reduce exposure of non-treated tissue (e.g., normal tissue) to laser irradiation. Conventionally, the identification of the target treatment structure of interest is performed manually by the operator, e.g. by endoscopically visualizing the target surgical site and its surroundings. Such manual methods may lack accuracy in at least some instances, for example due to close access to the operative site providing a limited surgical field of view, and may fail to determine the composition of the target. Biopsy techniques have been used to extract a target structure (e.g., tissue) from within the body for analysis of its components in vitro. However, in many clinical applications, it is desirable to determine the composition of tissue in vivo to reduce the time and complexity of the procedure and improve the therapeutic effect. For example, in laser lithotripsy, where laser light is applied to break up or fragment stones, automatically and in vivo identifying a particular type of stone (e.g., the chemical composition of the stone of the kidney or pancreaticobiliary duct or gallbladder) and distinguishing it from surrounding tissue will allow the physician to adjust the laser settings (e.g., power, exposure time, or firing angle) to more effectively ablate the target stone while avoiding irradiating non-therapeutic tissue near the target stone.

Conventional endoscopic laser therapy also has the limitation that the tissue type (e.g., composition) cannot be continuously monitored during surgery. There are many moving parts during endoscopic surgery and the tissue viewed from the endoscope may change throughout the surgery. Because conventional biopsy techniques require the removal of tissue samples to identify components, they are unable to monitor the composition of the tissue throughout the procedure. The continuous monitoring and identification of the structure type (e.g., soft or hard tissue type, composition of normal versus cancerous tissue, or stone structure) at the tip of the endoscope may provide the physician with more information to better accommodate treatment during surgery. For example, if a physician is pulverizing a kidney stone having a hard surface but a soft core, the continuous tissue composition information through the endoscope may allow the physician to adjust laser settings based on the continuously detected stone surface composition, e.g., from a first setting that performs better on the hard surface of the stone to a second, different setting that performs better on the soft core of the stone.

Some features as described herein may provide methods and devices that enable in vivo identification of components (e.g., soft or hard tissues) of various targets, such as in medical applications, through an endoscope. This may allow the user to continuously monitor the composition of the target viewed through the endoscope throughout the procedure. This also has the ability to be used in conjunction with a laser system, where the method can send feedback to the laser system to adjust settings based on the composition of the target. This feature may allow for immediate adjustment of the laser settings within the setting range of the original laser settings selected by the user.

Some features as described herein may be used to provide systems and methods that measure differences, such as chemical composition of a target, in vivo and suggest laser settings or automatically adjust laser settings to better achieve a desired effect. Examples of targets and applications include laser lithotripsy of kidney stones and laser cutting or vaporization of soft tissue. In one example, three main components are provided: a laser, a spectroscopy system, and a feedback analyzer. In an example, a controller of the laser system can automatically program the laser therapy with appropriate laser parameter settings based on the target composition. In an example, the laser may be controlled based on a machine learning algorithm trained with spectrometer data. Additionally or alternatively, a user (e.g., a physician) may continuously receive an indication of the target type during the procedure and be prompted to adjust the laser settings. By adjusting the laser settings and adapting the laser therapy to the component parts of the individual stone target, the stone ablation or fragmentation process can be performed faster and in a more energy efficient manner.

Some features as described herein may provide systems and methods for providing data input to a feedback analyzer to include internet connections and connections with other surgical devices having measurement functionality. Additionally, the laser system may provide input data to another system, such as an image processor, whereby the procedure monitor may display information related to the medical procedure to the user. For example, one example of this is to more clearly identify different soft tissue, vasculature, capsular tissue in the field of view, and different chemical compositions in the same target, such as a stone, during surgery.

Some features as described herein may provide systems and methods for identifying different target types, such as different tissue types or different stone types. In some cases, a single stone structure (e.g., a stone of the kidney, bladder, pancreatic bile duct, or gallbladder) may have two or more different components throughout its volume, such as brushite, calcium phosphate (CaP), Calcium Oxalate Dihydrate (COD), Calcium Oxalate Monohydrate (COM), Magnesium Ammonium Phosphate (MAP), or a cholesterol-or uric acid-based stone structure. For example, the target stone structure may include a first portion of COD and a second portion of COM. According to one aspect, the present disclosure describes systems and methods for continuously identifying different components contained in a single target (e.g., a single stone block) based on continuous collection and analysis of in vivo spectroscopic data. Treatment (e.g., laser therapy) may be adapted according to the identified target component. For example, in response to identification of a first component (e.g., COD) in the target stone block, the laser system may be programmed with a first laser parameter setting (e.g., power, exposure time, or firing angle, etc.), and deliver a laser beam to ablate or fragment the first portion accordingly. Spectroscopic data can be continuously collected and analyzed during laser therapy. In response to the identification of a second component (e.g., COM) different from the first component in the same target block being treated, the laser therapy may be adjusted, for example by programming the laser system with a second laser parameter setting different from the laser parameter setting (e.g., differential power or exposure time or firing angle, etc.), and delivering the laser beam accordingly to ablate or fragment a second portion of the same target block. In some examples, a plurality of different laser sources may be included in a laser system. Stone portions of different composition can be treated by different laser sources. The use of a suitable laser can be determined by the identification of the stone type.

Some features as described herein may be used in relation to laser systems in various applications where it may be advantageous to combine different types of laser sources. For example, the features described herein may be applicable to industrial or medical settings, such as medical diagnostics, treatment, and surgery. Features as described herein may be used in relation to endoscopy, laser surgery, laser lithotripsy, laser setup, and/or spectroscopy.

Fig. 1 shows a schematic diagram of an exemplary laser treatment system including a laser feedback control system 100 according to an illustrative example of the present disclosure. Example applications of the laser feedback control system 100 include integration into laser systems for many applications, such as industrial and/or medical applications for treating soft (e.g., non-calcified) or hard (e.g., calcified) tissue or stone structures such as the kidney or pancreatic bile duct or gall bladder. For example, the systems and methods disclosed herein may be used to provide precisely controlled therapeutic treatments, such as ablation, coagulation, vaporization, etc., or to ablate, fragment, or pulverize stone structures.

Referring to fig. 1, a laser feedback control system 100 may be in operative communication with one or more laser systems. Although fig. 1 shows the laser feedback system connected to the first laser system 102 and optionally (shown in phantom) to the second laser system 104, additional laser systems are contemplated within the scope of the present disclosure.

The first laser system 102 may include a first laser source 106, and associated components such as a power supply, a display, a cooling system, and the like. The first laser system 102 may also include a first optical fiber 108 operatively coupled to the first laser source 106. The first optical fiber 108 may be configured to transmit a laser output from the first laser source 106 to the target tissue 122.

In one example, the first laser source 106 may be configured to provide the first output 110. The first output 110 may extend over a first wavelength range. According to some aspects of the present disclosure, the first wavelength range may correspond to a portion of an absorption spectrum of the target tissue 122. The absorption spectrum represents an absorption coefficient in a laser wavelength range. Fig. 2A shows, by way of example, the absorption spectrum of water 210. Fig. 2B shows, by way of example, the absorption spectrum of oxyhemoglobin 221 and the absorption spectrum of hemoglobin 222. In such examples, the first output 110 may advantageously provide effective ablation and/or carbonization of the target tissue 122 because the first output 110 is within a wavelength range corresponding to an absorption spectrum of the tissue.

For example, the first laser source 106 may be configured such that the first output 110 emitted at the first wavelength range corresponds to high absorption of the incident first output 110 by tissue (e.g., over about 250 cm)^-1). In an example aspect, the first laser source 106 may emit the first output 110 between about 1900 nanometers and about 3000 nanometers (e.g., corresponding to high absorption by water) and/or between about 400 nanometers and about 520 nanometers (e.g., corresponding to high absorption by oxyhemoglobin and/or deoxyhemoglobin). Clearly, there are two main mechanisms by which light interacts with tissue: absorption and scattering. When the absorption of the tissue is high (absorption coefficient over 250 cm)^-1) When the absorption is low (absorption coefficient less than 250 cm), the first absorption mechanism dominates, and when the absorption is low^-1) For example, in the wavelength range of 800nm to 1100nm, the scattering mechanism dominates.

Various commercially available medical grade laser systems may be suitable for use with the first laser source 106. For example, a semiconductor laser may be used, such as an InXGa1-XN semiconductor laser that provides the first output 110 in a first wavelength range between about 515 nanometers and about 520 nanometers, or between about 370 nanometers and about 493 nanometers. Alternatively, Infrared (IR) lasers may be used, such as those summarized in table 1 below.

Table 1 exemplary list of IR lasers suitable for use with first laser source 106

Referring to fig. 1, the laser treatment system of the present disclosure may optionally include a second laser system 104. As previously mentioned, the second laser system 104 includes a second laser source 116 for providing a second output 120, and associated components such as a power supply, a display, a cooling system, and the like. The second laser system 104 may be operably separate from the first laser source 106, or in the alternative, the second laser system 104 may be operably coupled to the first laser source 106. In some examples, the second laser system 104 can include a second optical fiber 118 (separate from the first optical fiber 108), the second optical fiber 118 operably coupled to the second laser source 116 to transmit the second output 120. Alternatively, the first optical fiber 108 may be configured to transmit both the first output 110 and the second output 120.

In certain aspects, the second output 120 may extend over a second wavelength range different from the first wavelength range. Thus, there may not be any overlap between the first wavelength range and the second wavelength range. Alternatively, the first wavelength range and the second wavelength range may have at least partial overlap with each other. According to some aspects of the present disclosure, the second wavelength range may not correspond to a partial absorption spectrum of the target tissue 122, where the incident radiation is strongly absorbed by previously non-ablated or carbonized tissue (e.g., as shown in fig. 2). In some such aspects, the second output 120 may advantageously not ablate uncarbonated tissue. Further, in another example, the second output 120 may ablate carbonized tissue that has been previously ablated. In additional examples, the second output 120 may provide additional therapeutic effects. For example, the second output 120 may be more suitable for coagulating tissue or blood vessels.

The laser emission can be highly absorbed by soft or hard tissues, stones, etc. By way of example, fig. 3A-3C show absorption spectra for different tissue types. FIG. 3A shows respectivelyAbsorption spectra of normal tissue (pre-ablation) 311 and carbonized tissue (post-ablation) 312 are shown. Fig. 3B shows that in a certain wavelength range (e.g., 450nm to 850nm), the absorption spectrum decays exponentially with the laser wavelength. (sources of data shown in fig. 3A and 3B:http://omlc.org/spectra/ hemoglobin/). Fig. 3C shows optical absorption spectra measured in different media, including spectra 331A to 331C for water (at 75%, 100% and 4% concentrations, respectively), spectrum 332 for hemoglobin (Hb), spectrum 332 for oxygenated hemoglobin (HbO)₂) Spectrum 333, and spectra 334A to 334D for melanin (volume fractions for melanosomes are 2%, 13%, 30%, and 100%, respectively). (the source of the data shown in figure 3C,http:// www.americanlaserstudyclub.org/laser-surgery-education/). The wavelength for water absorption is in the range of 1900nm to 3000 nm. The wavelength for oxyhemoglobin and/or oxyhemoglobin is in the range of 400nm to 520 nm. Although many surgical lasers are highly absorbed in water or hemoglobin, there is a limit to the medium used to absorb water, which may be the reason why the interior of the endoscope becomes potentially damaged by the laser energy.

Fig. 4 shows the penetration depth of a laser output, such as second output 120. (sources of data shown in FIG. 4:http://www.americanlaserstudyclub.org/laser-surgery-education/). As seen therein, the second output 120 may be suitable for efficient coagulation due to a penetration depth comparable to the characteristic size of a small capillary (e.g., between about 5 μm and about 10 μm). Further, in certain examples, referring to fig. 3A and 3B, the second wavelength range may correspond to low absorption by non-carbonized tissue of the second output 120, but high absorption by already carbonized tissue (e.g., ablation by the first output 110). Notably, the spectral characteristics of the second output 120 correspond to the height of the second output 120 incident from the carbonized tissue (e.g., greater than about 250 cm)^-1) And (4) absorbing. Examples of suitable second laser sources include Ga having a second output 120 in a second wavelength range between about 750 nanometers and about 850 nanometers_XAl_1-XAs, or between about 904nm and about 1065nmIn of the second output 120 In a second wavelength range between meters_XGa_1-XAs。

Although two laser systems having partially overlapping spectra suitable for absorption by tissue (normal and/or carbonized) are described above, in an alternative example, the first laser system 102 may provide the second output 120 instead of the second laser system 104. In an example, the first laser system 102 may provide a first output 110 in a first wavelength range suitable for high absorption by previously non-ablated "normal" tissue (e.g., as shown in fig. 2) and a second output 120 in a second wavelength range corresponding to low absorption by tissue prior to being carbonized and/or more suitable for coagulation (e.g., as shown in fig. 3A and 3B). The first laser system 102 may provide additional output in additional wavelength ranges.

Reference is again made to fig. 1. According to an example, the laser treatment system includes a laser feedback control system 100. Referring now to fig. 5, as previously described, the laser feedback control system 100 may analyze the feedback signal 130 from the target tissue 122 and control the first laser system 102 and/or the second laser system 104 to produce an appropriate laser output to provide a desired therapeutic effect. For example, the laser feedback control system 100 may monitor characteristics of the target tissue 122 during a treatment process (e.g., ablation) to determine whether the tissue was properly ablated prior to another treatment process (e.g., coagulation of blood vessels). Accordingly, the laser feedback control system 100 may include a feedback analyzer 140.

With continued reference to fig. 5, according to one example, the feedback analyzer 140 can monitor spectroscopic properties of tissue. The spectroscopic properties may include characteristics such as reflectivity, absorption index, and the like. Accordingly, the feedback analyzer 140 may include a spectroscopy sensor 142. The spectroscopy sensor 142 may include a fourier transform infrared spectrometer (FTIR), a raman spectrometer, a UV-VIS reflection spectrometer, a fluorescence spectrometer, or the like. FTIR is a method for routine, simple and rapid material analysis. This technique has relatively good spatial resolution and provides information about the chemical composition of the material. Raman spectroscopy has good accuracy in identifying hard and soft tissue components. It is also useful for determining the distribution of components within an object as a high spatial resolution technique. UV-VIS reflectance spectroscopy is a method of collecting information from light reflected off an object, similar to that produced from the eye or a color image taken by a high resolution camera, but more quantitative and more objective. Reflection spectroscopy provides information about a material because light reflection and absorption depend on its chemical composition and surface properties. Unique information about both the surface and volume properties of the sample can also be obtained using this technique. Reflectance spectroscopy can be a valuable technique for identifying the composition of hard or soft tissue. Fluorescence spectroscopy is electromagnetic spectroscopy that analyzes fluorescence from a sample. It involves the use of a light beam, typically ultraviolet light, which excites a material compound, typically in the visible or IR region, and causes the material compound to emit light. The method is suitable for analysis of some organic components such as hard and soft tissues.

In an example, the feedback analyzer 140 may optionally include an imaging sensor 144 (e.g., a CCD or CMOS camera sensitive to Ultraviolet (UV), Visible (VIS), or Infrared (IR) wavelengths). In some examples, the spectroscopy sensor 142 may include more than a single type of spectrometer or imaging camera set forth herein to enhance sensing and detection of various features (e.g., carbonized and non-carbonized tissue, vasculature, etc.).

In some examples, the spectroscopy sensor 142 (also referred to as a spectrometer) may include any of the spectrometers listed herein, and may additionally rely on the imaging capabilities of an endoscope used during the treatment procedure. For example, endoscopes can be used to visualize anatomical features during a treatment procedure (e.g., laser ablation of tumors). In such a case, the imaging capabilities of the endoscope may be enhanced by the spectroscopic sensor 142. For example, conventional endoscopes may provide narrow band imaging suitable for enhancing visualization of anatomical features (e.g., lesions, tumors, vasculature, etc.). By combining the spectroscopic sensor 142 with endoscopic imaging (white light and/or narrow band imaging), detection of tissue characteristics such as carbonization levels can be increased to precisely control delivery of therapeutic treatments.

Referring again to fig. 5, the spectroscopy sensor 142 may be operatively coupled to a signal detection fiber 150. In such an example, the signal detection fiber 150 may have optical characteristics suitable for transmitting spectroscopic signals from the tissue to the spectroscopic sensor 142. Alternatively, the spectroscopic sensor 142 may be operatively coupled to the first optical fiber 108 of the first laser system 102 and/or the second optical fiber 118 of the second laser system 104 and thereby detect the spectroscopic signal via the first optical fiber 108 and/or the second optical fiber 118.

With continued reference to fig. 1 and 5, the laser feedback control system 100 includes a laser controller 160, the laser controller 160 in operable communication with each of the spectroscopy sensor 142, the first laser system 102, and the optional second laser system 104. Laser controller 160 may control one or more laser systems (e.g., first laser system 102, second laser system 104, and/or any additional laser systems) operatively connected thereto according to one or more control algorithms described herein to control laser output from the one or more laser systems to produce a desired therapeutic effect in target tissue 122.

The laser controller 160 may include a processor, such as a microprocessor, a Digital Signal Processor (DSP), an Application Specific Integrated Circuit (ASIC), a Field Programmable Gate Array (FPGA) or any other equivalent integrated or discrete logic circuitry, as well as any combination of these components for performing one or more functions attributed to the laser controller 160. Optionally, the laser controller 160 may be coupled to the spectroscopy sensor 142 and one or more laser systems (e.g., the first laser system 102, the second laser system 104, and optional laser systems not shown herein) by wired or wireless connections.

The laser controller 160 may communicate with the feedback analyzer 140 (e.g., via a wired or wireless connection) to receive one or more feedback signals from the feedback analyzer 140. Laser controller 160 may determine one or more characteristics of target tissue 122 based on the feedback signal, as will be further described herein. For example, laser controller 160 may compare the amplitude of the feedback signal to exhibit a minimum amplitude and a maximum amplitude and determine a characteristic of the tissue (e.g., carbonization, coagulation, etc.).

In some examples, the feedback analyzer 140 may continuously monitor the target tissue 122 and continuously communicate with the laser controller 160 to provide the feedback signal. Thus, the laser controller 160 may continue to maintain the laser system in one or more states until a change in the amplitude of the feedback signal is detected. When a change in the amplitude of the spectroscopic signal is detected, the laser controller 160 can communicate with one or more laser systems and change their state to provide the desired therapeutic effect. Alternatively or additionally, laser controller 160 may communicate with an operator (e.g., a healthcare professional) and display one or more outputs via one or more output systems indicative of the feedback signal, and may optionally instruct the operator to perform one or more treatment procedures with the first laser system and/or the second laser system to provide a desired therapeutic effect.

In the illustrative examples described herein, laser controller 160 may control one or more laser systems by changing the state of the laser systems. According to one aspect, laser controller 160 may control each laser system independently. For example, the laser controller 160 may send different control signals to each laser system to control each laser system independently of the other laser systems. Alternatively, the laser controller 160 may send a common signal to control one or more laser systems.

In some examples, each of the laser systems may be associated with two different states: a first state in which the laser system produces laser output, and a second state in which the laser system does not produce laser output. For example, the first laser system 102 may have a first state that produces the first output 110 (e.g., within a first wavelength range) and a second state that does not produce the first output 110. Similarly, the second laser system 104 may have a first state that produces the second output 120 (e.g., within a second wavelength range) and a second state that does not produce the second output 120. In such an example, the laser controller 160 may control one or more laser systems by sending a control signal that changes the state of the laser system from a first state to a second state or from the second state to the first state. Further, each laser system may optionally have additional states, such as a third state that produces laser output in a different wavelength range. Accordingly, additional control signals may be sent by the laser controller 160 to the laser systems to change their state from their current state to one or more additional states (e.g., first to third states, second to third states, third to first states, and third to second states) to produce laser outputs that provide the desired therapeutic effect.

Example laser System control Algorithm

Fig. 6 and 7 are flow diagrams illustrating examples of algorithms for controlling one or more laser systems using the laser feedback control system 100 according to some examples as described in this disclosure. According to the control algorithm 600 shown in fig. 6, a first signal (e.g., a spectroscopic signal) can be detected by the feedback analyzer 140 (e.g., the spectroscopic sensor 142 or the imaging sensor 144) at step 602. At step 604, the laser controller 160 may receive a first signal from the feedback analyzer 140. The first signal may correspond to a first characteristic. At step 606, the laser controller 160 may determine whether the first signal is generally equal to a first preset value. For example, the laser controller 160 may compare the amplitude of the first signal to a target value or a preset extremum (e.g., a maximum amplitude or a minimum amplitude) and determine a first characteristic of the target tissue 122. The first characteristic may be indicative of a characteristic of the tissue after receiving a therapeutic treatment (e.g., ablating or carbonizing the tissue). The laser controller 160 may determine that the desired therapeutic effect has been obtained based on the first characteristic (the comparison between the first signal and the first preset value), and may send a first control signal to the first laser system 102 to change from the first state of the first laser system 102 to the second state of the first laser system 102 at step 608. According to an example, this may result in the first laser system 102 no longer producing the first output 110, thereby providing a satisfactory therapeutic effect (e.g., ablation). Alternatively, if at step 606 it is determined that the first signal is generally not equal to the first preset (insufficient ablation), the laser controller may not send any control signals and the feedback analyzer may continue to monitor the first signal.

Optionally, at step 612, the feedback analyzer 140 may receive a second signal different from the first signal. The second signal may be indicative of a first characteristic of the target tissue having a second preset value. For example, the amplitude of the reflected light from the tissue may be different in the second signal than in the first signal. At optional step 614, a second signal may be received by laser controller 160. At optional step 616, laser controller 160 may determine whether the second signal is generally equal to a second preset. For example, the second signal (e.g., a spectroscopic signal or image) may indicate that the target tissue 122 is not carbonized by absorption by the first output 110 (e.g., the measured signal amplitude is less than a preset maximum amplitude of the spectroscopic signal or image of ablated tissue). In some cases, such conditions may indicate insufficient ablation or other unsatisfactory therapeutic effect, and it may be desirable to continue to deliver laser output so that tissue may be ablated. Accordingly, at optional step 618, the laser controller 160 may communicate with the first laser system 102 to send a second control signal. The second control system may maintain the first laser system 102 in the first state (e.g., continue to transmit the first output 110). Alternatively, if the first laser system is in the second state (e.g., off), then at optional step 620, the second control signal may change the state of the first laser system to the first state (e.g., on), e.g., to continue delivering additional ablation to the target tissue.

At optional step 620, after laser controller 160 determines satisfactory delivery of the treatment condition, laser controller 160 may perform additional control operations to deliver additional laser output (e.g., at a different wavelength) to deliver additional treatment effects.

Fig. 7 shows a control algorithm for controlling a dual laser system. Algorithm 700 may be applicable where laser controller 160 is in operative communication with two or more laser systems. In some such examples, the first laser system 102 may be configured to transmit the first output 110 (e.g., within a first wavelength range) and the second laser system 104 may be configured to transmit the second output 120 (e.g., within a second wavelength range different from the first wavelength range), as previously described. The control algorithm 700 may control the first laser system 102, the second laser system 104, and optionally additional laser systems.

In accordance with the control algorithm 700, a first signal (e.g., a spectroscopic signal or image) can be detected by the feedback analyzer 140 at step 702. At step 704, the laser controller 160 may receive a first signal from the feedback analyzer 140. At step 706, the laser controller 160 may determine whether the first signal is generally equal to a first preset value (e.g., within a first preset specified tolerance). For example, the laser controller 160 may compare the amplitude of the first signal to a target value or a preset extremum (e.g., a maximum amplitude or a minimum amplitude) and determine a first characteristic of the target tissue 122. The first characteristic may be indicative of a tissue characteristic after receiving a therapeutic treatment (e.g., ablating or carbonizing tissue). The laser controller 160 may determine that a desired therapeutic effect has been obtained based on the first characteristic meeting a target value or preset criteria, and may send a first control signal to the first laser system 102 to change from a first state of the first laser system 102 to a second state of the first laser system 102 at step 708. For example, the laser controller 160 may determine that ablation has been satisfactory based on reflected light from ablated tissue, and send a first control signal to the first laser system to transition the first laser system to an off state. Alternatively, in an illustrative example, the laser controller 160 may provide an output to an operator (e.g., a healthcare professional) to indicate that a desired therapeutic effect has been achieved, and/or to indicate to the operator to change the state of the first laser system to an "off" state.

At step 708, the laser controller 160 may also send a fourth signal to the second laser system 104 to change from the second state of the second laser system 104 to the first state of the second laser system 104. For example, the second laser system 104 may be more suitable for ablating carbonized tissue. Thus, upon detecting that the tissue has been sufficiently carbonized (e.g., at step 708), in some cases, the laser controller 160 may send a first control signal to turn off the first laser system 102 and a fourth control signal to turn on the second laser system 104. An example timing diagram of the states of the first and second laser systems is shown in fig. 8.

In some examples, the first control signal and the fourth control signal may be transmitted simultaneously. Alternatively, the first control signal and the fourth control signal may be transmitted sequentially.

Returning to fig. 7, at optional step 710, the feedback analyzer 140 may detect a second signal (e.g., a spectroscopic signal or image) that is different from the first signal. For example, the second signal may indicate that the target tissue 122 is not carbonized by absorption by the first output 110 (e.g., the measured signal amplitude is greater than a preset maximum amplitude of the spectroscopic signal for ablated tissue). In some cases, such conditions may indicate insufficient ablation or other unsatisfactory therapeutic effect, and it may be desirable to continue to deliver laser output so that tissue may be ablated. At optional step 712, the laser controller may receive the second signal and, at optional step 714, compare the second signal to a second preset value. If the second signal is generally equal to the second preset value (e.g., within a second preset specified tolerance margin), then at optional step 716, the laser controller 160 may send a second control signal to the first laser system and a third control signal to the second laser system. An example timing diagram of the states of the first and second laser systems is shown in fig. 8.

In some examples, the second control signal may change the first laser system from the second state (e.g., off) to the first state (e.g., on). Alternatively, if the first laser system is in the first state (e.g., on), the second control signal may maintain the first laser system 102 in the first state (e.g., to continue transmitting the first output 110). Optionally, at step 716, if the second laser system 104 is in its first state, the laser controller 160 may send a third control signal to the second laser system 104, thereby changing the second laser system 104 from the first state (e.g., on) of the second laser system 104 to the second state (e.g., off) of the second laser system 104. Alternatively, if the second laser system is in the second state, the third control signal may hold the second laser system 104 in the second state (e.g., off).

According to some examples, the first state of each of the first laser system 102 and the second laser system 104 may correspond to the generation of the first output 110 by the first laser source 106 and the second output 120 by the second laser source 116, respectively. Thus, the first state of each of the first laser system 102 and the second laser system 104 may represent an "on" state. In some such examples, the second state of each of the first laser system 102 and the second laser system 104 may correspond to an "off" state.

Referring to fig. 5, the laser feedback control system 100 may include one or more output systems 170. One or more output systems 170 may communicate with and/or transmit signals to a user and/or other systems, such as an irrigation aspiration/pumping system for therapeutic treatment, or an optical display controller, or other systems. In some examples, the output system 170 may include a display 172. The display 172 may be a screen (e.g., a touch screen), or in the alternative, may simply be a visual indicator (e.g., one or more colored LED lights). In additional examples, output system 170 may include an auditory output system 174 (e.g., a speaker, an alarm system, etc.) capable of providing an auditory signal. The output system 170 may provide one or more outputs (e.g., an LED light of a first color, a first message on a screen, an alarm sound of a first tone) to indicate that a desired therapeutic effect has been achieved. An output may be provided, for example, at step 610 and optionally at step 620. In further alternative examples, the output system 170 may provide one or more different outputs when the desired therapeutic effect is not achieved. For example, the output system 170 may provide one or more outputs (e.g., an LED light of a second color, a second message on a screen, an alarm sound of a second tone) to indicate that the desired therapeutic effect is not being achieved. Such output may prompt an operator (healthcare professional) to take one or more steps (e.g., perform additional processing steps using one or more laser systems to provide additional laser output).

Fig. 8 shows a timing diagram for a dual laser system with a laser feedback control system 100 according to an example of tissue ablation and coagulation by using two optical wavelengths. However, as previously described, the laser feedback control system 100 may be used with single or multiple optical wavelength systems to optimize delivery of laser therapy or other types of therapeutic effects to the target tissue 122. The therapeutic effects may be delivered in any order, including simultaneously. Alternatively, the therapeutic effect may be delivered at different times.

According to an example, the laser energy from the first and

second laser systems

102, 104 can be delivered to a target (e.g., a tissue surface), e.g., can be delivered to the target continuously in an example. The first laser system and the second laser system may transmit respective laser energies via the same optical fiber. Alternatively, the first laser system and the second laser system may deliver respective laser energies via respective different optical fibers. Having an amplitude A_maxIs reflected from the tissue surface and may be detected and analyzed by the feedback analyzer 140. The first laser system and the second laser system may alternate their respective operating states (e.g., on state or off state). As shown in fig. 8, the first laser system 102 may be switched to or remain in its first state (e.g., on) 820A, while the second laser system 104 may be switched to or remain in a second state (e.g., off). The first laser may be used to ablate and carbonize tissue. During operation of the first laser system 102, the first signal may be received by the laser controller 160 and may indicate high absorption by the tissue until its amplitude decreases to the threshold level a_minUntil now. From the first laser system 102The wavelength of the output of (a) may be in a first wavelength range in the absorption spectrum of the target, for example a wavelength suitable for effective carbonization of the target tissue. Tissue has a high absorption of laser energy. In an example, the first laser output is in the UV-VIS or deep infrared wavelength range.

The laser controller 160 may then change the state of the laser systems such that the first laser system 102 is in the second state (e.g., off) and the second laser system 104 is in the first state (e.g., on) 830A. The output from the second laser system 104 may be highly absorbed by the carbonized tissue, such that the carbonized tissue is ablated, effectively removing the carbonization. The wavelength of the output from the second laser system 104 may be within a second wavelength range in the absorption spectrum of the target. The second wavelength range may be different from the first wavelength range of the output from the first laser system 102. The wavelength of the output from the second laser system 104 may also be suitable for efficient coagulation. In an example, the second laser output is in an infrared wavelength range (e.g., 100 μm to 300 μm). Due to the decarbonization process, the amplitude of the signal (e.g., the second signal) returns to near the initial level A_max. The laser controller 160 may change the state of the laser accordingly such that the first laser system 102 is in a first state (e.g., on) and the second laser system 104 is in a second state (e.g., off). This process may be repeated such that the first and

second laser systems

102 and 104 are repeatedly switched to their on

states

820B and 830B, respectively, in an alternating manner as shown in fig. 8 until the desired tissue ablation and/or coagulation is achieved. In some examples, the optical feedback signal 810 as discussed herein may be provided to an electrosurgical system that may controllably adjust and optimize electrosurgical energy other than laser energy.

Example endoscopic System with target recognition

Fig. 9 to 11 show how the target component analysis can be performed entirely endoscopically. Target composition analysis can be performed via spectroscopy through laser fibers and potential camera devices on the distal end of the digital endoscope.

Fig. 9A to 9B show an example of an endoscope into which a laser optical fiber is inserted. The elongate body portion of the exemplary endoscope 910 contains various components including a laser fiber 912, an illumination source 914, and an imaging device 916. The laser fiber 912 is an example of the optical path 108 of the laser system 102 or the laser system 202. The laser fiber 912 may extend along a working channel 913 in the elongate body of the endoscope 910. In some examples, the laser fiber 912 may be separate from the endoscope. For example, the laser fiber 912 may be fed along the working channel of the endoscope prior to use and retrieved from the working channel of the endoscope after use.

The illumination source 914 may be part of a visualization system that allows an operator to visualize a target structure (e.g., tissue or stone structure). An example of an illumination source may include one or more LEDs configured to emit light distally away from a distal end of an elongated body of an endoscope to illuminate a region of a target structure. In an example, illumination source 914 can emit white light to illuminate the target structure. White light can cause the practitioner to observe discoloration or other color-based effects on the stone or tissue near the distal end of the endoscope body. In an example, the illumination source 914 can emit blue light to illuminate the target structure. Blue light may be well suited to show thermal tissue spreading and thus detect lesions in tissue. Other colors and/or color bands may also be used, such as red, amber, yellow, green, or others.

The camera 916 is part of a visualization system. Camera 916 is an example of imaging sensor 244. Camera 916 may capture a video image or one or more still images of the illuminated target structure and surrounding environment. The video images may be real-time, or nearly real-time with relatively short processing delays, so that the practitioner may observe the target structure as the practitioner manipulates the endoscope. The camera 916 may include a lens and a multi-pixel sensor located at a focal plane of the lens. The sensor may be a color sensor, such as a sensor that provides an intensity value for red, green, and blue light for each pixel in a video image. The circuit board may generate a digital video signal representing the captured video image of the illuminated stone. The digital video signal may have a video refresh rate of 10Hz, 20Hz, 24Hz, 25Hz, 30Hz, 40Hz, 50Hz, 60Hz, or another suitable video refresh rate.

Fig. 10A-10B illustrate examples of feedback controlled laser treatment systems. In fig. 10A, a laser treatment system 1000A includes an endoscope 910 integrated with a laser treatment system 1010 that receives feedback control of camera feedback. Laser treatment system 1000A, which is an example of laser treatment system 100, includes endoscope 910, feedback controlled laser treatment system 1010, laser source 1020, and light source 1030. In various examples, a portion or all of feedback controlled laser treatment system 1010 may be embedded in endoscope 910.

Feedback-controlled laser therapy system 1010, which is an example of laser feedback control system 200, includes a spectrometer 1011 (an example of a spectroscopy sensor 242), a feedback analyzer 1012 (an example of at least a portion of feedback analyzer 240), and a laser controller 1013 (an example of laser controller 260). The laser source 1020 is an example of the laser system 202, and the laser source 1020 may be coupled to a laser fiber 912. Fiber optic integrated laser systems can be used for endoscopic procedures because they are capable of transmitting laser energy through flexible endoscopes and effectively treating hard and soft tissues. These laser systems produce a laser output beam over a wide wavelength range from the UV to the IR region (200nm to 10000 nm). Some fiber-integrated lasers produce output in a wavelength range that is highly absorbed by soft or hard tissue, for example 1900nm to 3000nm for water absorption or 400nm to 520nm for oxyhemoglobin absorption and/or deoxyhemoglobin absorption. Table 1 above is a summary of IR lasers emitted in the high water absorption range of 1900nm to 3000 nm.

Some fiber-integrated lasers produce output in a wavelength range that is minimally absorbed by the targeted soft or hard tissue. These types of lasers provide efficient tissue coagulation due to the penetration depth being similar to the diameter of small capillaries (5 to 10 μm). An example of the laser source 1020 may include In that emits UV-VIS_XGa_1-XN semiconductor lasers, e.g. GaN lasers In which 515nm to 520nm are emitted, In which 370nm to 493nm are emitted_XGa_1-XN laser, Ga emitting in the range of 750nm to 850nm_XAl_1-XAs laser or In which 904nm to 1065nm is emitted_XGa_1-XAs lasers, and the like.

The light source 1030 may generate an electromagnetic radiation signal that may be transmitted to the target structure 122 via a first optical path extending along the elongate body of the endoscope. The first optical path may be located within working channel 913. In an example, the first optical path may be an optical fiber separate from the laser fiber 912. In another example, as shown in FIG. 10A, the electromagnetic radiation signal may be transmitted through the same laser fiber 912 that is used to transmit the laser beam. The electromagnetic radiation exits the distal end of the first optical path and is projected to the target structure and the surrounding environment. As shown in fig. 10A, the target structure is within the field of view of the endoscopic camera 916 such that the endoscopic camera 916, e.g., a CCD or CMOS camera, may collect signals reflected from the target structure 122 in response to electromagnetic radiation projected onto the target structure and the surrounding environment, generate an imaging signal 1050 of the target structure, and transmit the imaging signal to the feedback controlled laser treatment system 1010. In some examples, imaging systems other than CCD or CMOS cameras, such as laser scanning, may be used to collect the spectroscopic responses.

In addition to or instead of the feedback signal (e.g., imaging signal) generated and transmitted by the camera system 916, in some examples, signals reflected from the target structure may additionally or alternatively be collected and transmitted to the feedback-controlled laser treatment system 1010 through a separate fiber channel or laser fiber, such as associated with the endoscope 910. Fig. 10B shows an example of a laser therapy system 1000B, the laser therapy system 1000B including an endoscope 910 integrated with a feedback controlled laser therapy system 1010, the feedback controlled laser therapy system 1010 configured to receive spectroscopy sensor feedback. The reflected spectroscopy signal 1070 (which is an example of the feedback signal 130 of fig. 1 and 2) can travel back to the feedback controlled laser therapy system 1010 through the same optical path (e.g., the laser fiber 912) used to transmit the electromagnetic radiation from the light source 1030 to the target structure. In another example, the reflected spectroscopy signal 1070 may travel to the feedback controlled laser therapy system 1010 through a second optical path, such as a fiber channel separate from the first optical fiber that transmits the electromagnetic radiation from the light source 1030 to the target structure.

The feedback controlled laser therapy system 1010 may analyze one or more feedback signals (e.g., the imaging signal 1050 of the target structure or the reflected spectroscopy signal 1070) to determine the operating state of the laser source 1020. The spectrometer 1011 may produce one or more spectroscopic properties from the one or more feedback signals, for example by using one or more of an FTIR spectrometer, a raman spectrometer, a UV-VIS-IR spectrometer or a fluorescence spectrometer, as discussed above with reference to the spectroscopic sensor 242. Feedback analyzer 1012 may be configured to identify or classify the target structure into one of a plurality of structure classes or structure types, e.g., by using one or more of target detector 246 or target classifier 248. Laser controller 1013 may be configured to determine an operating mode of laser system 1020, as similarly discussed above with reference to fig. 2.

The light source 1030 may generate electromagnetic radiation in the optical range from UV to IR. Table 2 below presents an example of a light source 1030 for a spectroscopy system suitable for the examples discussed herein.

Table 2: light source for spectroscopy systems

In some examples, the feedback analyzer 1012 may determine a distance 1060 between the distal end of the laser fiber 912 and the target structure 122, or a distance 1060 between the distal end of the optical path for receiving and transmitting the reflected signal back to the spectrometer 1011 and the target structure 122 (as shown in fig. 10A). The distance 1060 can be calculated using spectroscopic properties, such as the reflection spectrum produced by the spectrometer 1011. If the distance 1060 satisfies a condition, e.g., falls below a threshold (d)_th) Is as follows or inWithin the specified laser emission range, laser controller 1013 may control laser source 1020 to deliver laser energy to target structure 122. In an example, if the target structure 122 is identified as an intended treatment structure type (e.g., a specified soft tissue type or a specified stone type), but the target structure 122 is not within the range of the laser (e.g., d)>d_th) Laser controller 1013 may generate a control signal to "lock" laser source 1020 (i.e., prevent laser source 1020 from emitting). Information about the distance 1060 and the target structure are outside the laser range (d)>d_th) The practitioner may then adjust the endoscope 910, e.g., reposition the distal end of the laser fiber 912 to move closer to the target. The distance 1060 and the target structure type may be continuously monitored and determined and presented to the practitioner. When the target is identified as the desired treatment structure type and within the range of the laser (d)<＝d_th) At this time, the laser controller 1013 may generate a control signal to "unlock" the laser source 1020, and the laser source 1020 may be targeted and launched at the target structure 122 according to a laser operating mode (e.g., power setting). An example of a method for calculating the distance 1060 from spectroscopy data is discussed below, for example with reference to fig. 24A and 24D.

In some examples, the spectrometer 1011 may be configured to further use information about the geometry and positioning of an optical path configured to transmit electromagnetic radiation from the light source to the target to produce a spectroscopic property (e.g., a reflectance spectrum). For example, the outer diameter of the laser fiber 912 or the outer diameter of a separate optical path used to transmit the spectroscopic signal reflected from the target to the spectrometer 1011, or the angle at which the fiber or path protrudes from the endoscope 910, can affect the intensity of the reflected signal. The outer diameter and/or protrusion angle may be measured and provided to the spectrometer 1011 to obtain reflectance spectrum data. As discussed above, the distance 1060 between the target structure and the distal end of the optical fiber may be calculated using spectral data, the measured outer diameter of the optical fiber or optical path and its angle of protrusion, and/or input signals from the endoscope image processor.

Fig. 11A to 11B are diagrams illustrating an example of an endoscope system for recognizing a target using a diagnostic beam. As shown in fig. 11A, an endoscopic system 1100A may include an endoscope 1110 and an optical fiber 1120A that may be inserted through a working channel 1112 of the endoscope 1110. The endoscope 1110 may include at least one endoscopic illumination source 1130 or otherwise be coupled to the at least one endoscopic illumination source 1130 via the endoscope port 1114. The at least one endoscope illumination source 1130 may be controllable to provide different amounts of illumination. Upon insertion of the optical fiber 1120A through the working channel 1112, the optical fiber 1120A may be coupled to a non-endoscopic illumination source 1140, for example, via an endoscopic port 1114. The non-endoscopic illumination source 1140 may be different from the at least one endoscopic illumination source 1130. Non-endoscopic illumination source 1140 may emit diagnostic light beam 1142 through optical fiber 1120A and proximate distal end 1116 of endoscope 1110. The optical fiber 1120A may direct the diagnostic beam 1142 at the target 1001. In an example, the non-endoscopic illumination source 1140 may be a laser source configured to emit a diagnostic beam comprising a laser beam. In various examples, a white light lamp, led light source, or fluoroscopic light source may be inserted through the working channel of an endoscope or through another port, such as a laparoscopic port.

The endoscope system 1100A may include a controller 1150. The controller 1150 may controllably operate the at least one endoscopic illumination source 1130 in different modes of operation, including, for example, a first mode having a first amount of illumination and a second mode having a second amount of illumination that is lower than the first amount of illumination. In an example, the controller 1150 may generate such a control signal to change the illumination mode (e.g., from a first mode to a second mode) in response to a trigger signal. In an example, the endoscope includes an imaging system 1160 that can take an image of a subject 1001, and the controller 1150 can generate control signals to the endoscope to change an illumination mode (e.g., from a first mode to a second mode) in response to a change in brightness or intensity of the subject image. The first mode is hereinafter referred to as a high illumination mode, and the second mode is hereinafter referred to as a low illumination mode. In an example, the high illumination mode and the low illumination mode can be provided by respective different endoscope illumination sources, e.g., a first endoscope illumination source configured to emit illumination light in the high illumination mode and a second different endoscope illumination source configured to emit illumination light in the low illumination mode. Illumination light may be emitted near the distal end 1116 of the endoscope 1110. In an example, the illumination light may travel through an optical path within working channel 1112 that is different from optical fiber 1120A. The optical path may direct the illumination light 1132 at the same target 1001 on which the diagnostic beam is projected.

When the at least one endoscopic illumination source 1130 changes from the high illumination mode to the low illumination mode, the controller 1150 may generate control signals to the non-endoscopic illumination source 1140 to emit a diagnostic light beam 1142 (e.g., a laser beam having a lower than therapeutic energy level). In an example, the low illumination mode includes turning off illumination of the endoscope. By dimming the illumination at the target site in the low illumination mode, the reflection of the diagnostic light beam incident on the target from the target may be enhanced, which may help improve target recognition.

In some examples, when the illumination mode is in the second mode, the controller 1150 may generate control signals to the display to display an image of the target, where the image is a previous image or a modified image of a current image of the target. The controller 1150 may determine the composition of the target based on the diagnostic beam incident on the target and the light from the diagnostic beam reflected from the target. In an example, the controller 1150 may determine a first component of a first portion of the stone target and determine a second, different component of a second portion of the stone target. Based on the identified composition of the different portions of the target, the controller 1150 may program or generate recommendations for programming the first laser setting to target a first portion of the stone target. The controller 1150 may also program or generate recommendations for a second laser setting that is different from the first laser setting to target a second portion of the stone target.

In an example, after non-endoscopic illumination source 1140 has ceased emitting diagnostic light beam 1142, controller 1150 may generate a control signal to the endoscope to change the illumination mode from a low illumination mode back to a high illumination mode.

Fig. 11B shows an example of an endoscope system 1100B, the endoscope system 1100B being a variation of the endoscope system 1100A. In this example, diagnostic beam 1142 may be transmitted through optical fiber 1120B. Unlike fiber 1120A, which is inserted into working channel 1112 of endoscope 1110, fiber 1120B may be provided separately from working channel 1112. In some examples, as shown in fig. 11B, diagnostic light beams 1142 can be delivered through a secondary port 1115, such as a laparoscopic port in the examples, separate from the endoscope port 1114 used to deliver the endoscope illumination light. Optical fiber 1120B may be positioned such that both distal end 116 of endoscope 1110 and the distal end of optical fiber 1120B target 1001.

Fig. 12 and 13A-13B are graphs showing reflectance spectrum data for identifying different types of targets via UV-VIS spectroscopy or UV-VIS-IR spectroscopy, for example, for identifying the composition of several different types of kidney stones. Reflectance spectral data were collected by targeting a UV-VIS spectrometer or a UV-VIS-IR spectrometer to each image of the five major types of kidney stones including calcium oxalate stone (monohydrate), calcium oxalate stone (dihydrate), calcium phosphate stone, struvite stone, and uric acid stone. In an example, the electromagnetic radiation may include one or more ultraviolet wavelengths between 10nm and 400 nm. In another example, as shown in fig. 12, reflectance spectra for identifying different types of targets may be recorded from a spectrometer over a wavelength range of 200nm to 1100 nm. There is shown a reflectance spectrum of a kidney stone component comprising magnesium ammonium phosphate (AM MAG) hydrate, calcium oxalate (CA) monohydrate, calcium oxalate (CA) hydrate, calcium phosphate (CA) and uric acid. The reflection spectra of these stone constituents are more distinguishable in the lower wavelength range (e.g., below 400nm) than in the higher wavelength range (e.g., above 400 nm). Fig. 13A shows a portion of the reflectance spectrum shown in fig. 12 over the wavelength range of 200nm to 400nm, including magnesium ammonium phosphate hydrate spectrum 1310, calcium oxalate monohydrate spectrum 1320, calcium oxalate hydrate spectrum 1330, calcium phosphate spectrum 1340, and uric acid spectrum 1350. The UV wavelength range is a region where differences can be identified in the spectrum of the stone image. FIG. 13B shows reflectance spectra of various kidney stone components over the wavelength range of 400nm to 700nm, including cystine spectrum 1360, uric acid spectrum 1370, and calcium oxalate monohydrate spectrum 1380. Using UV-VIS spectroscopy or UV-VIS-IR spectroscopy, it is possible to distinguish between different types of targets, such as different types of kidney stones.

Thus, since the UV wavelength range is promising, for example, in distinguishing different target components, such as kidney stones, there is a need for a light source within the system that will allow analysis of this region. FIG. 14 shows

light peaks

1410, 1420, 1430, and 1440 covering respective portions of the UV wavelength range around 250nm, 280nm, 310nm, and 340nm, respectively. Fig. 15 overlaps these light peaks 1410-1440 with the normalized reflection spectra of several types of stones from fig. 13A-13B. These light peaks 1410 to 1440 demonstrate potential light sources that would allow the spectrometer to analyze the composition of the target in UV wavelengths.

Fig. 16A shows examples of normalized reflectance spectra captured on a UV-VIS spectrometer from various tissue types, including cartilage spectra 1610, bone spectra 1620, muscle spectra 1630, fat spectra 1640, and liver tissue spectra 1650. Fig. 16B shows another example of normalized reflectance spectra captured on a UV-VIS spectrometer from various soft and hard tissues, including cartilage spectra 1610, bone spectra 1620, muscle spectra 1630, fat spectra 1640, liver tissue spectra 1650, and blood vessel spectra 1660. The reflectance spectrum data shown in fig. 16A-16B demonstrate the feasibility of analyzing the composition of a target according to methods that may be used within the working channel of an endoscope. Similar to the spectra captured from stone images, the UV-VIS region can be used to identify different types of targets. Fig. 16C shows an example of FTIR spectra of typical stone components, and fig. 16D is an example FTIR spectrum for some soft and hard tissue components.

Exemplary laser treatment System

The features as described herein may be used in relation to laser systems for various applications in which it may be advantageous to incorporate different types of laser sources. For example, the features described herein may be applicable to industrial or medical settings, such as medical diagnostics, treatment, and surgery.

The features as described herein may be used with a spectroscopy system that may be used in conjunction with a fiber optic integrated laser system and an endoscope.

Fig. 17-18 show schematic diagrams of laser treatment systems according to various examples as described in this disclosure. The laser treatment system may include a laser system configured to deliver laser energy directed at a target, and a laser feedback control system configured to be coupled to the laser system. The laser system may include one or more laser modules 1710A-1710N (e.g., solid-state laser modules) that may emit similar or different wavelengths from UV to IR. The number of integrated laser modules, their output power, emission range, pulse shape and pulse train are selected to balance system cost and performance required to deliver the desired effect to the target.

One or more laser modules 1710A-1710N may be integrated with the optical fiber and included in the laser coupling system. Fiber optic integrated laser systems can be used for endoscopic procedures because they are capable of passing laser energy through a flexible endoscope and effectively treating hard and soft tissues. These laser systems produce a laser output beam over a wide wavelength range from the UV to the IR region (e.g., 200nm to 10000 nm). Some fiber-optic integrated lasers produce output in a wavelength range that is highly absorbed by soft or hard tissue, for example 1900nm to 3000nm for water absorption or 400nm to 520nm for oxyhemoglobin absorption and/or deoxyhemoglobin absorption. Various IR lasers may be used as laser sources in endoscopic surgery, such as those described above with reference to table 1.

Laser modules 1710A-1710N may each be comprised of multiple solid state laser diodes integrated into an optical fiber to increase output power and deliver emissions to a target. Some fiber-integrated lasers produce output in a wavelength range that is minimally absorbed by the targeted soft or hard tissue. These types of lasers provide efficient tissue coagulation due to the penetration depth being similar to the diameter of small capillaries (5 to 10 μm). The fiber integrated laser modules 1710A-1710N described according to various examples in this disclosure have several advantages. In an example, the light emitted by the laser module has a symmetrical beam quality, a circular and smooth (uniform) intensity distribution. A compact cooling device is integrated into the laser module and makes the entire system compact. The fiber-integrated laser modules 1710A to 1710N can be easily combined with additional fiber optic components. Additionally, fiber-integrated laser modules 1710A-1710N support standard fiber connectors that allow the modules to operate well with most optical modules without alignment. Furthermore, the fiber-integrated laser modules 1710A to 1710N can be easily replaced without changing the alignment of the laser coupling system.

In some examples, the laser module may produce laser output in a wavelength range that is highly absorbed by some materials, such as soft or hard tissue, stone, bone, teeth, etc., for example 1900nm to 3000nm for water absorption or 400nm to 520nm for oxyhemoglobin and/or deoxyhemoglobin absorption, as shown in fig. 3C. In some examples, the laser module may produce laser output in a wavelength range that is low-absorbed by a target, such as soft or hard tissue, rocks, bone, teeth, and the like. This type of laser provides more efficient tissue coagulation because the penetration depth is similar to the diameter of a small capillary (e.g., 5 μm to 10 μm), as shown in fig. 3C. Commercially available solid-state lasers are potential emission sources for laser modules. An example of a laser source for a laser module may include In that emits UV-VIS_XGa_1-XN semiconductor lasers, e.g. GaN (emission 515nm to 520nm) or In_XGa_1-XN (370 nm to 493nm emission), GaXAl1-XAs laser (750 nm to 850nm emission) or InXGa1-XAs laser (904 nm to 1065nm emission). Such laser sources may also be applied in tissue coagulation applications.

The laser feedback control system may include one or more subsystems including, for example, a spectroscopy system 1720, a feedback analyzer 1730, and a laser controller 1740.

Spectroscopy system 1720

The spectroscopy system 1720 can transmit a control light signal from a light source to a target such as, but not limited to, a stone, soft or hard tissue, a bond, or a dental or industrial target, and collect spectral response data reflected from the target. The response may be transmitted to the spectrometer by a separate fiber optic, laser fiber, or endoscopic system. The spectrometer may send the digital spectral data to a system feedback analyzer 1730. Examples of light sources for spectroscopy systems that cover the optical range from UV to IR may include those described above with reference to table 2. Fig. 20 shows a schematic diagram of a spectroscopy system 1720 with a feedback analyzer 1730 in an example.

Optical spectroscopy is a powerful method that can be used for simple and fast analysis of organic and inorganic materials. According to various examples described in this disclosure, the spectroscopy light source may be integrated into a separate fiber channel, laser fiber, or endoscope system. The light source signal reflected from the target can be quickly collected and transmitted to the spectrometer by an imaging system containing a detector such as may be included in a digital endoscope, for example a CCD or CMOS sensor. Other imaging systems such as laser scanning may also be used to collect the spectroscopic response. Optical spectroscopy has several advantages. It can be easily integrated with the fiber laser delivery system 1701. It is a non-destructive technique for detecting and analyzing the chemical composition of a material, and analysis can be performed in real time. Optical spectroscopy can be used to analyze different types of materials including, for example, hard and soft tissues, stone structures, and the like.

Various spectroscopy techniques can be used, alone or in combination, to analyze the target chemical composition and produce spectroscopic feedback. Examples of such spectroscopy techniques may include UV-VIS reflection spectroscopy, fluorescence spectroscopy, fourier transform infrared spectroscopy (FTIR), raman spectroscopy, or the like. Table 2 above presents examples of light sources for spectroscopy systems covering the optical region from UV to IR and suitable for use in the examples. Tungsten halogen light sources are commonly used for spectroscopic measurements in the visible and near IR range. Deuterium light sources are known for their stable output and they are used for UV absorption or reflectance measurements. The combination of halogen and deuterium lamps produces a broad spectral range light source that provides a smooth spectrum from 200nm to 2500 nm. Xenon light sources are used in applications where long lifetime and high output power are required, for example for fluorescence measurements. LED and laser diode light sources provide high power at precise wavelengths; they have a long life, a short warm-up time and a high stability. The spectroscopy light source can be integrated into a separate fiber channel, laser fiber, or endoscope system. The light source signal reflected from the target can be quickly detected and transmitted to the spectrometer through a separate fiber channel or laser fiber.

Feedback analyzer 1730

Feedback analyzer 1730 can receive input from various sources including spectroscopy response data from a spectrometer to suggest or directly adjust laser system operating parameters. In an example, the feedback analyzer 1730 can compare the spectroscopic response data to an available database archive of target composition data. Based on the spectroscopy system feedback, the signal analyzer detects the target material composition and suggests a laser operating mode (also referred to as laser settings), e.g., for operating parameters of at least one laser module, to achieve effective tissue treatment of the identified tissue composition. Examples of operating parameters may include at least one laser wavelength, pulse or Continuous Wave (CW) emission mode, peak pulse power, pulse energy, pulse rate, pulse shape, and simultaneous or sequential emission of pulses from at least one laser module. Although not explicitly described, sequential pulses include bursts that combine to deliver selected pulse energies. A pulse as described herein generally refers to the time between starting and stopping lasing from a laser module. The intensity of the laser energy during each pulse may be varied to have a shape with an increasing or decreasing ramp or sinusoidal profile, or any other shape alone or in combination with a pulse sequence, as long as the selected average laser power is maintained. For example, if there is only one pulse, a 2W average power setting with a pulse energy of 1J occurs at a frequency of 2 Hz. However, energy may also be delivered as two 0.5J pulses in rapid succession, occurring at a rate of 2 Hz. Each of these pulses may have a similar pulse shape or a different pulse shape. Feedback analyzer 1730 utilizes algorithms and input data to directly adjust or suggest laser operating parameters, such as those described in the examples above.

In some examples, the feedback analyzer 1730 may utilize the input data to calculate and control the distance between the distal end of the laser delivery system 1701 (optical fiber) and the target based on specially developed algorithms. In the case of a moving target (e.g., a stone), the feedback analyzer 1730 may adjust or suggest the laser operating parameters that use a vapor bubble in water to create a pumping effect to pull the target beyond a predetermined threshold closer to the distal end of the optical fiber. This feature minimizes the effort required by the user to maintain an effective treatment distance from the moving target. The distance between the target and the distal ends of the optical fibers may be calculated using the spectral data, the known outer diameter of each optical fiber and its angle of protrusion from the endoscope, and/or input signals from the endoscope image processor. Fig. 24A to 24D are illustrated by way of an example method of calculating the distance between the distal end of the laser delivery system 1701 (optical fiber) and the target. The dependence of the spectroscopic reflectance signal on the distance between the target and the laser delivery system 1701 is shown in fig. 24A-24B. Fig. 24A shows an example of reflected signal intensity at 730nm measured at different distances between the tissue and the distal end of the spectroscopy probe. Fig. 24B shows an example of reflected signal intensities at 450nm measured at different distances between the tissue and the distal end of the spectroscopic probe. Such dependence can be determined using spectral data and information about the laser delivery system geometry. The analysis of the spectral signals allows a fast estimation of the distance and communicates this information to the user.

Fig. 24C is an exemplary algorithm for distance calculation between the fiber and the tissue target. In one example, a spectroscopy system sends a control light signal from a light source to a target, collects spectral response data from the target, communicates the response signal to a spectrometer, and sends digital spectral data from the spectrometer to a feedback analyzer. As shown in fig. 24C, calibration curve 1000 represents the relationship between the intensity of the spectroscopic reflection signal (e.g., the spectroscopic signal reflected from the target structure in response to electromagnetic radiation) and the distance 1060 between the distal end of the optical fiber and the target structure (e.g., as shown in fig. 10-11) using the feedback signal reflected from the target structure. When the target structure is projected with electromagnetic radiation of a particular wavelength (e.g., 450nm or 730nm), the calibration curve 1000 may be generated by measuring the reflected signal intensity at different distances between the tissue and the distal end of the spectroscopic probe. Analysis of the spectral signal allows for a fast estimation of the distance by referring to the calibration curve.

An exemplary process for generating the calibration curve is as follows. First, a reference value for each distance may be calculated. The calibration curve itself may not be used for identifying the distance because the light reflection intensity depends on the reflectance of the sample or the like. An example of a reference value for eliminating the influence of the reflectance of the sample is as follows:

reference value dI/dx 1/I (1)

During an intra-body surgical procedure, the operator can move the optical fiber or endoscope with continuous recording of the spectroscopic feedback until the reflectance spectrum of the target tissue component can be detected.

Referring to FIG. 24C, the reflected signal may have a strength of I₁Distance x of₁The first spectrum is measured. At this time, x₁Is unknown, and the curve of the reflected signal intensity is unknown. The fiber or endoscope distal end (reflected light detector) may then continue to be moved, and the distance x may be measured₂Corresponding intensity of next reflected light I₂。x₂Can be close to x₁So that x is₁And x₂The curve between can be approximately linear. At this time, x₁、x₂And the curve of the reflected signal intensity is unknown. Can use I₁、I₂And Δ (x)₂-x₁) A comparison value was calculated as follows:

comparison value ═ Δ (I)₂-I₁)/Δ(x₂-x₁)*1/I₁ (2)

Then, the reference value that is the same as the comparison value is searched for among the reference values. If only one reference value (x) is found to be present_r) The same as the comparison value given in equation (2), x can be determined_rIs x₁The distance of (c). If there are two reference values (x)_r1，x_r2) Then canTo continue moving the fiber or endoscope distal end (reflected light detector) and can measure the distance x from₃Corresponding intensity of next reflected light I₃。x₃Can be close to x₂So that x is₂And x₃The curve between can be approximately linear. At this time, x₁、x₂、x₃And the curve of the reflected signal intensity is unknown. Can use I₁、I₂、I₃、Δ(x₂-x₁) And Δ (x)₃-x₂) A new comparison value is calculated as follows.

Comparison value ═ Δ (I)₃-I₂)/Δ(x₃-x₂)*1/I₂ (3)

Then, search for x in the reference value_r1+Δ(x₂-x₁) And x_r2+Δ(x₂-x₁) The same reference value. The reference value may be compared with the comparison value given in equation (3). The distance whose reference value is more similar to the comparison value is estimated as the actual distance.

Referring to fig. 24D, during an intra-body surgical procedure, an example method may include moving a fiber or endoscope and continuously recording spectroscopic feedback until a reflected spectrum of a target constituent will be detected. In the main case of the far end of the spectrum moving towards the target, the intensity of the reflected light detected will initially be weaker and will increase as the distance between the target and the end of the optical fibre decreases. For example, the first spectrum is where the reflected signal intensity is I₁Distance d of₁Measured above. Continuing to move the fiber or endoscope distal end slightly toward the target and continuously collecting the reflected data, and the method can measure the distance d₂Corresponding intensity of next reflected light I₂. Then, the method may include varying the slope of the reflected signal intensity by Δ (I)₂-I₁)/Δ(d₂-d₁) The value of (c) is calculated. The calculated slope may be normalized in order to make its value independent of the reflected signal strength. The final formula for calculating the slope of the change in reflected signal strength at the measured distance becomes:

slope (normalization))＝[Δ(I₂-I₁)/Δ(d₂-d₁)]/I_o (4)

Wherein: i is_oEqual average (I1, I2)

The method may then compare the calculated slope to the slope on the calibration curve in the library to allow the desired distance to be estimated. All calculations can be done quickly using software.

Fig. 25A-25B illustrate the effect of the distance between the tissue and the distal end of the spectroscopic probe on the spectrum of reflected light from the target. Fig. 25A shows exemplary normalized UV-VIS reflectance spectra for various soft tissue types, including bladder endothelial spectrum 2511, stomach endothelial spectrum 2512, stomach smooth muscle spectrum 2513, sub-ureteral spectrum 2514, ureteral endothelial spectrum 2515, renal calyx spectrum 2516, bladder muscle spectrum 2517, and medullary spectrum 2518. Fig. 25B shows exemplary UV-VIS reflectance spectra of a particular tissue recorded at different distances between the tissue and the distal end of the spectroscopic probe, for example, from 0 inches to 0.25 inches. Fig. 25A shows some examples of animal soft tissue spectra. Fig. 25B presents exemplary UV-VIS reflectance spectra of tissue recorded at different distances between the tissue and the distal end of the spectroscopic probe. In this example, the reflected signal intensities at the two spectral maxima of 450nm and 730nm were measured at different distances between the target tissue and the presented distal end of the spectroscopic probe, as discussed above with reference to fig. 24A-24B.

Laser controller 1740

The laser controller 1740 may be integrated with the laser coupling system. A laser coupling system couples one or more laser modules (e.g., solid state laser modules) into an optical fiber. The laser controller 1740 may be coupled to a feedback analyzer 1730, and the feedback analyzer 1730 may send an optimization signal with suggested settings directly to the laser controller 1740 (automatic mode), or request operator approval to adjust the laser settings (semi-automatic mode). Fig. 17 is a schematic diagram of a fully automated laser system. Fig. 18 is a schematic diagram of a semi-autonomous laser system in which the system requires user approval, for example, via a user interface including an input 1850 and a display 1860. In an example, the laser settings may be adjusted within a set range, which in an example may be predetermined by a user at the start of the procedure.

In some examples, laser controller 1740 may combine two or more laser pulse trains to create a combined laser pulse train. Fig. 19A shows an example in which a laser controller 1740 can generate multiple (e.g., N) laser pulse trains 1910A-1910N, combine the laser pulse trains 1910A-1910N into a combined pulse train 1920, and expose a target with the combined pulse train at 1930. Fig. 19B is a diagram showing an example of an output laser pulse train 1942 combined by three

different laser trains

1941A, 1941B, and 1941C emitted from different laser modules. As shown therein, laser strings 1941A, 1941B, and 1941C may be turned on at different times and/or turned off at different times according to a feedback analyzer signal. In the example as shown therein, the output combined laser pulse train 1942 may include portions in which two or more of the laser trains 1941A, 1941B, and 1941C overlap in time.

With the combination of laser modules 1910A-1910N, spectroscopy system 1720, and feedback analyzer 1730, laser feedback system 1740 as described herein can continuously identify the composition of a target through an endoscope and update the laser settings throughout the process.

The main components of the laser system can be easily customized to the targeted medical procedure. For example, laser controller 1740 supports different laser types and combinations thereof. This allows a wide range of output signal options including power, wavelength, pulse rate, pulse shape and profile, individual laser pulse trains and combined laser pulse trains. The operating mode of the laser system may be automatically adjusted or suggested for each desired optical effect. The spectroscopy system collects information about the target material that is useful for diagnostic purposes and to confirm that the laser parameters are optimal for the target. Feedback analyzer 1730 can automatically optimize the operating mode of the laser system and reduce the risk of human error.

Internet of things (IoT) system 1750

In some examples, the laser system may include an optional IoT system 1750 that supports storing a spectrum database archive on cloud 1752, supports fast access to the spectrum and best settings database archive, and enables communication between cloud 1752 and feedback analyzer 1730. Cloud storage of data supports the use of Artificial Intelligence (AI) techniques to provide input to the feedback analyzer 1730 and supports improved immediate access to algorithms and databases.

IoT system 1750 may include a network in which components of a laser system may communicate and interact with other components over the internet according to various examples described herein. IoT supports fast access to spectrum database archives stored on cloud 1752 and performs communication between cloud 1752 and feedback analyzer 1730. In addition, all components of the laser system may be monitored and controlled remotely over a network, if desired. An example of such a successful connection is the medical internet of things (also referred to as health internet of things), which is an available application of the IoT for medical and health-related purposes including data collection and analysis for research and monitoring.

In various examples, IoT system 1750 may support access to various cloud resources, including cloud-based detection, identification, or classification of a target structure (e.g., a stone structure or anatomical tissue). In some examples, a Machine Learning (ML) engine may be implemented in cloud 1752 to provide cloud-based target detection, recognition, or classification services. The ML engine may include a trained ML model (e.g., machine-readable instructions executable on one or more microprocessors). The ML engine may receive target spectroscopy data from the laser system or retrieve target spectroscopy data stored in the cloud 1752, perform target detection, identification, or classification, and generate an output, e.g., a marker representing a tissue type (e.g., normal tissue or cancerous lesion or tissue at a particular anatomical site) or a stone type (e.g., a stone of a kidney, bladder, pancreatic bile duct, or gall bladder with a particular composition). Among other clinical data collected from a patient before or during surgery, the target spectroscopic data can be automatically uploaded to the cloud 1752 at the end of the procedure or other predetermined times. Alternatively, a system user (e.g., a clinician) may be prompted to upload data to the cloud 1752. In some examples, the output may additionally include a probability that the target is identified as tissue or stone, or a probability that the target is classified as a particular tissue type or stone type. Such cloud services may be used by system users (e.g., clinicians) to obtain near real-time information about targeted tissues or stones within the body, for example, while performing endoscopic laser surgery.

In some examples, the ML engine may include a training module configured to train the ML model using training data, such as stored in the cloud 1752. The training data may include spectroscopy data associated with target information, such as a label identifying a target type (e.g., stone type or tissue type). The training data may include laboratory data based on spectroscopic analysis of multiple tissue types and/or stone types. Additionally or alternatively, the training data may include clinical data acquired from a plurality of patients in vitro or in vivo. In some examples, patient identification information may be removed from patient clinical data (e.g., spectroscopic data) prior to using the patient clinical data for uploading to the cloud 1752 to train an ML model or perform target detection, identification, or classification using the trained ML model. The system may associate the de-identified patient clinical data with a label (e.g., hospital, laser system identification, time of surgery) that identifies the data source. The clinician may analyze and confirm the target type (e.g., stone or tissue type) during or after the procedure and correlate the target type with the de-identified patient clinical data to form training data. Using de-identified patient clinics may advantageously increase the robustness of the cloud-based ML model, as additional data from a large patient population may be included to train the ML model. This may also improve the performance of ML models to identify rare stone types because spectroscopic data from rare stone types is difficult to obtain clinically or from a laboratory.

Various ML model architectures and algorithms can be used, such as decision trees, neural networks, deep learning networks, support vector machines, and the like. In some examples, the training of the ML model may be performed continuously or periodically, or in near real-time as additional spectroscopy data is made available. Training involves algorithmically adjusting one or more ML model parameters until the ML model being trained satisfies specified training convergence criteria. The resulting trained ML model may be used for cloud-based target detection, recognition, or classification. With ML models trained by utilizing large amounts of data stored in the cloud 1752 and additional data added thereto continuously or periodically, ML-based target recognition with cloud connectivity as described herein may improve the accuracy and robustness of in vivo target detection, recognition, and classification.

Exemplary endoscopic laser System

Fig. 21A-21D illustrate examples of endoscopic laser systems 2100A and 2100B including an endoscope 2110 with integrated multi-fiber attachment and a surgical laser system including a feedback controlled laser treatment system 1010 and a laser source 1020 as shown in fig. 10A. Alternatively, the spectroscopic response can be collected by an imaging system containing a detector, such as a CCD or CMOS sensor, and transmitted to the spectrometer. Target composition analysis may be performed via spectroscopy through one or more cores of the multi-fiber attachment while illuminating the target with a light source transmitted through one or more other cores of the multi-fiber attachment.

As shown in fig. 21A, the endoscopic laser system 2100A includes a multi-fiber attachment including an optical path 2116 for transmitting spectroscopic signals back to the spectrometer 1011 and for delivering surgical laser energy from the laser source 1020 to the target structure. In an example, the optical pathway 2116 includes an optical fiber embedded within and extending along an elongate body of the endoscope 2110. In another example, optical pathway 2116 includes two or more optical fibers extending along the elongate body of endoscope 2110. Laser controller 1013 may control the timing of the laser emission such that the transmission of the spectroscopy signal and the delivery of laser energy occur at different times or simultaneously.

The multi-fiber accessory may include two or more light source fibers 2114 embedded in and extending along the elongated body of the endoscope 2110. By way of example and not limitation, fig. 21C illustrates a radial cross-sectional view of the elongate body of endoscope 2110 with a plurality of light source fibers 2114 and optical pathways 2116 positioned longitudinally within the elongate body of the endoscope, and with the light source fibers 2114 distributed radially around the optical pathways 2116, e.g., along the circumference of the optical pathways 2116 on a radial cross-section relative to the elongate body of the endoscope. In the example shown in fig. 21C, the optical pathway 2116 can be located substantially at the central longitudinal axis of the elongate body of the endoscope 2110. By way of example and not limitation, as shown in fig. 21C, six source optical fibers may be positioned around optical pathway 2116. Other numbers of source fibers and/or other locations of source fibers relative to optical path 2116 may be used. For example, fig. 21D shows two source fibers 2114 positioned radially at opposite sides of optical pathway 2116. The light source fiber 2114 may be coupled to a light source 1030. Alternatively, light source fibers 2114 may be coupled to illumination sources 914 as shown in fig. 9A-9B. Light from an endoscope light source, illumination source 914 (e.g., one or more LEDs) or a remote light source 1030, such as external to the endoscope, can function to illuminate the target and produce a spectroscopic signal that is reflected from the target surface, which can be collected for spectroscopic analysis. The feedback analyzer 1012 can determine a distance 1060 between the distal end of the endoscope 2110 and the target structure 122, as similarly shown in fig. 10-11.

Fig. 21B shows an endoscopic laser system 2100B including a multi-fiber attachment. Instead of delivering laser energy through optical path 2116, a separate laser fiber 2120 may be used to deliver surgical laser energy from laser source 1020 to the target structure. The optical path 2116 serves as a dedicated spectroscopic signal fiber for transmitting spectroscopic signals back to the spectrometer 1011.

Fig. 22 and 23A-23B illustrate examples of multi-fiber systems that may be used in spectroscopy fiber delivery systems such as those discussed above with reference to fig. 21A-21D. In the example shown in fig. 22, the multi-fiber system 2200 includes a first fiber 2210 coupled to a light source and configured to direct illumination light at a target, and a separate second fiber 2220 coupled to a spectrometer and configured to transmit a reflection signal indicative of a spectroscopic characteristic of the target (e.g., light reflected from the target) to the spectrometer.

Fig. 23A-23B are diagrams of an exemplary multi-fiber attachment with a source light input and a spectroscopic feedback signal. As shown in fig. 23A, the multi-fiber attachment 2300A can include a distal portion 2310, a transition portion 2320A, and a proximal portion 2330A. The distal portion 2310 includes a shaft that may be sized and shaped to enclose the first and second

optical fibers

2210, 2220, with the transition portion 2320A proximate the distal portion 2310. The first and second

optical fibers

2210, 2220 can be embedded in and extend along a longitudinal axis of the distal portion 2310. The shaft may be sized and shaped to extend through a working channel of an endoscope. In some examples, the first optical fiber 2210 may include two or more optical fibers, each coupled to a light source, and/or the second optical fiber 2220 may include one or more optical fibers. In some examples, as shown in fig. 21C-21D, the second optical fibers 2220 can be radially distributed around the first optical fibers 2210. In an example, at least one of the second optical fibers 2220 may extend along a substantially central longitudinal axis of the shaft. Two or more first optical fibers 2210 may be positioned radially at opposite sides of the second optical fiber 2220 extending along the central longitudinal axis of the shaft.

The proximal portion 2330A includes a first connector 2332 configured to connect to a light source and a second connector 2334 configured to connect to a spectrometer. A transition 2320A interconnects the distal end portion 2310 and the proximal end portion 2330A, and the transition 2320A may be configured to couple a first connector 2332 to a first optical fiber 2210 and a second connector 2334 to a second optical fiber 2220. Thus, the transition portion 2320A provides a transition for the

fibers

2210 and 2220 from the respective first and

second connectors

2332 and 2334 to a single axis.

The shaft may include an insertable distal end 2312 extending distally from the distal portion 2310. The insertable distal end 2312 may be configured to be inserted into a patient. The proximal portion 2300A can be associated with (e.g., included in) a handle for a user to operate the multifiber accessory 2300A. In an example, at least a portion of the multi-fiber attachment 2300A (e.g., one or more of the distal portion 2310, the transition portion 2320A, or the proximal portion 2330A) can be included in or insertable into a working channel of an endoscope.

Fig. 23B illustrates another example of a multi-fiber accessory 2300B, which is a variation of the multi-fiber accessory 2300A. In the example shown in fig. 23B, the proximal end portion 2330B can further include a third connector 2336, the third connector 2336 configured to couple the laser source to one of the

optical fibers

2210 or 2220. Similar to fig. 23A, a transition portion 2320B interconnects the distal portion 2310 and the proximal portion 2330B. Laser energy generated from a laser source may be transmitted from the proximal end portion 2330B to the distal end portion 2310 through one of the

optical fibers

2210 or 2220 and delivered to the target treatment site via the insertable distal end 2312. In some examples, the multi-fiber attachment 2300B can also include laser fibers other than the

fibers

2210 or 2220. The laser fiber may be positioned in a working channel of the endoscope, such as within the shaft. Laser energy generated from a laser source may be transmitted to the distal portion 2310 through a laser fiber.

Exemplary applications of laser systems

Laser systems as described according to various examples in this disclosure may be used in many applications, such as endoscopic hard tissue surgery or endoscopic soft tissue surgery, to improve the effectiveness of ablation, coagulation, vaporization, or other laser effects.

One application of laser systems for tissue surgery applications is in relation to providing effective tissue ablation and coagulation using laser systems, rather than two different foot pedals as are often used on commercial devices such as laser and plasma devices. An example system uses two or more solid state laser modules emitting at two different wavelengths coupled into a laser controller by fiber optics and a UV-VIS reflection spectroscopy system that passes the spectral signals to a feedback analyzer that recommends alternative settings to the user prior to adjustment.

In one example, two laser modules may be provided that include: a first laser module that can emit at high tissue absorption light wavelengths for more efficient ablation/carbonization processes, and a second laser module that can emit at lower tissue absorption light wavelengths for more efficient coagulation, e.g., due to penetration depth similar to the diameter of a small capillary. Examples of the first laser module may include: UV-VIS emitting InXGa1-XN semiconductor laser: GaN (emission 515nm to 520 nm); InXGa1-XN (emission 370nm to 493nm), or IR lasers emitting in the high water absorption range 1900nm to 3000nm as summarized in Table 1. Examples of the second laser module may include: GaXAl1-XAs in which 750nm to 850nm is emitted, or InXGa1-XAs in which 904nm to 1065nm is emitted. Both the first laser module and the second laser module may be coupled into the laser controller through a laser coupling system.

The spectroscopy light source may be integrated into a separate fiber channel, laser fiber, or endoscope system. The spectroscopic light source signal reflected from the target can be quickly detected and transmitted to the spectrometer through a separate fiber channel or laser fiber. Alternatively, the spectroscopy system may collect spectroscopy signals from an imaging system that contains a detector, such as a CCD or CMOS sensor. Based on the spectroscopy system feedback, the signal analyzer can detect the target material composition and suggest a first laser module setting or a second laser module setting to achieve effective tissue treatment, and communicate a signal to an output system for providing suggested setting information to a user.

This example allows tissue ablation and coagulation by utilizing two or more laser pulses where the wavelength of the light is controlled by a feedback analyzer system. However, feedback control may be used with single or multiple optical wavelength systems to optimize the simultaneous delivery of specific effects to a target. From the user's perspective only, these effects may be simultaneous; features as described herein are not limited to transmitting wavelengths at exactly the same time.

An example time operation diagram for such a laser with spectroscopic feedback is presented in fig. 8. As described therein, wherein the amplitude is A_maxIs continuously transmitted to and reflected from the target surface and is detected and analyzed by a signal analyzer.The user may then turn the first laser on, or keep the first laser on while the second laser is off after selecting to ablate soft tissue. During operation of the first laser, the optical feedback signal is highly absorbed by the carbonized tissue until its amplitude decreases to a threshold level A_minUntil now. The signal analyzer then changes the state of the lasers such that the first laser is off and the second laser is on. The second laser light is highly absorbed by the carbonized tissue; the carbonized tissue is thus ablated, which effectively removes the carbonization. The wavelength of the second laser also provides effective coagulation. The amplitude of the optical feedback pulse returns to near the initial level A due to the decarburization process_max. When this occurs, the signal analyzer changes the state of the laser back to the first laser on and the second laser off. The above process may be repeated until the desired amount of tissue ablation and coagulation is achieved.

Another application of laser systems relates to efficient laser lithotripsy procedures for fragmenting kidney or bladder stones in a patient. The present application relates to the following processes: multiple wavelength laser energy, having a wavelength that is less absorbed by the target, is used to first heat the target and then to fragment the target, such as a kidney stone, for example, using a more strongly absorbing wavelength. During laser lithotripsy, kidney stone fragmentation or bladder stone fragmentation may occur due to photothermal effects. High laser energy can be absorbed by the stone block, causing the temperature to rise rapidly above the threshold for chemical decomposition, causing its decomposition and fragmentation. In one example, laser lithotripsy may include a two-stage process. The first stage is a pre-heating stage, in which the block is heated using laser energy of a first wavelength, which causes low absorption of laser energy by the block. The subsequent second stage involves applying laser energy having a second wavelength, which causes a stronger absorption of the laser energy by the rock than the first wavelength. This multi-step process allows for better control of steam bubble generation and reduces the intensity of shock waves generated during fragmentation (reducing the stone recoil effect).

In an example, a laser system utilizes two or more solid state laser modules emitting at two different wavelengths coupled into a laser controller by optical fibers and a spectroscopy system that transmits a spectral signal to a feedback analyzer that advises a user of an alternative setting prior to adjustment. The first laser module can emit lower stone/water absorption optical wavelengths for effective preheating; and the second laser module can emit high stone/water absorption light wavelengths for more efficient stone fragmentation. The first laser module in this application can produce an output at a lower stone or water absorption wavelength. The laser provides effective and uniform preheating of the stone. Examples of the first laser source for the first laser module may include GaXAl1-XAs in which 750nm to 850nm is emitted, or InXGa1-XAs in which 904nm to 1065nm is emitted. Examples of the second laser source may include an InXGa1-XN semiconductor laser emitting UV-VIS laser light, such as a GaN laser emitting 515 to 520nm therein, or an InXGa1-XN laser emitting 370 to 493nm therein, or an IR laser emitting in the high water and stone absorption range 1900 to 3000nm and summarized in table 1.

Both the first laser module and the second laser module may be coupled to the laser controller through a laser coupling system. The spectroscopy light source may be integrated into a separate fiber channel, laser fiber, or endoscope system. The spectroscopic light source signal reflected from the target can be quickly detected and transmitted to the spectrometer through a separate fiber channel or laser fiber. Alternatively, the spectroscopy system may collect spectroscopic signals from an imaging system containing a detector, such as a CCD or CMOS sensor.

Based on the spectroscopy system feedback, the signal analyzer can detect the target material composition and suggest a first laser module setting or a second laser module setting to achieve an efficient multi-step stone processing procedure, and transmit a signal to an output system for providing suggested setting information to a user. The laser system can deliver effective stone preheating and fragmentation simultaneously by using two or more laser pulses from the laser module, with the optical wavelength controlled by the feedback analyzer system. However, feedback control can be used with single or multiple optical wavelength systems to optimize simultaneous delivery of specific effects on a target stone constituent.

Yet another application of laser systems is in relation to procedures for performing ablation of hard tissue, such as teeth, bone, etc., where high laser output power is required. The effectiveness of soft tissue laser surgery is based on cryogenic water vaporization at 100 ℃, however, the hard tissue cutting process requires very high ablation temperatures-up to 5,000 ℃. To deliver enhanced output power, the laser system may couple a greater number of laser modules to increase the integrated output power to a level sufficient to treat the target. The following lasers may be used as the emission source: UV-VIS emitting InXGa1-XN semiconductor laser: GaN (emission 515 to 520 nm); InXGa1-XN (emission 370nm to 493nm) or IR lasers 1900nm to 3000nm as summarized in Table 1. Laser sources suitable for use in the laser module of this example may include, for example, a GaXAl1-XAs laser in which 750nm to 850nm are emitted, or an InXGa1-XAs laser in which 904nm to 1065nm are emitted.

The laser module may be integrated into a laser controller having a laser coupling system. To achieve the required high power, a large number of laser modules may be coupled into the system. The spectroscopy light source may be integrated into a separate fiber channel, laser fiber, or endoscope system. The spectroscopic light source signal reflected from the target can be quickly detected and transmitted to the spectrometer through a separate fiber channel or laser fiber. Alternatively, the spectroscopy system may collect spectroscopic signals from an imaging system containing a detector, such as a CCD or CMOS sensor.

Based on the spectroscopy system feedback, the signal analyzer can detect the target material composition and suggest laser module settings and laser module numbers to achieve the desired output power, effective multi-step treatment process, and transmit signals to an output system for providing suggested setting information to the user. By increasing the number of laser modules included in a treatment process using two or more laser pulses in which the wavelength of light is controlled by a feedback analyzer system, the laser system can deliver the required high laser output power simultaneously. Feedback control can be used with single or multiple optical wavelength systems to optimize simultaneous delivery of specific effects on a target stone component. From the user's perspective only, these effects may be simultaneous; but are not limited to transmitting wavelengths at exactly the same time.

Features as described herein may be used to provide a method of identifying a target component. In some cases, the target may be a medical target, such as soft and hard tissues within the body through the use of surgical attachments. The accessory may be used endoscopically or laparoscopically. The accessory may consist of a single device containing multiple optical fibers with the purpose that at least one fiber provides the light source illumination and at least one fiber directs the reflected light to the spectrometer. This allows the user to continuously monitor the composition of the tissue or target throughout the procedure with or without direct endoscopic visualization. This also has the ability to be used in conjunction with a laser system, where the accessory can send feedback to the laser system to adjust settings based on the composition of the tissue or target. This feature will allow for immediate adjustment of the laser settings within the set range of the original laser settings selected by the user. The features as described herein may be used with a spectroscopy system that may be used with a fiber-integrated laser system. The spectroscopy light source may be transmitted through at least one optical fiber in a multi-fiber attachment. The light source signal reflected from the target can be quickly collected and transmitted to the spectrometer via additional fibers in the multi-fiber.

An example method may utilize spectroscopy input data to calculate and control the distance between the distal end of the laser delivery system 1701 (e.g., an optical fiber) and the tissue or target based on an algorithm. The method may be applied to both soft and hard tissue types of intra-body surgical procedures. The distance between the target and the distal end of the optical fiber may be calculated based on analysis of the spectral data. The outer diameter of each fiber and the angle at which it protrudes from the endoscope affect the intensity of the reflected light; it is measured to obtain spectral data. Using features as described herein, distances can be calculated without sequential illumination by light having different numerical aperture values.

In the case of moving stones, the method may control the distance and may adjust or suggest using vapor bubbles in the water to create the laser operating parameters of the pumping effect to pull targets that exceed a predetermined threshold closer to the distal end of the fiber. This feature minimizes the effort required by the user to maintain an effective treatment distance from the moving target.

UV-VIS-IR reflectance spectroscopy according to various examples discussed in this disclosure may be used alone or in combination with other spectroscopy techniques to create spectroscopic feedback including analyzing material chemistry and measuring reflected light intensity during in vivo diagnostic or therapeutic procedures. The reflected light may yield the same information as the eye or a color image taken by a high resolution camera, but it is more quantitative and objective. Reflection spectroscopy provides information about materials because light reflection and absorption depend on their chemical composition and surface properties. This technique can also be used to obtain unique information about both the surface and bulk properties of the sample.

Yet another application of laser systems is in processes relating to identifying the type of target, such as determining the composition of a stone target during laser lithotripsy. According to some examples discussed herein, an endoscope system has a light source, and the light source provides illumination light through a light guide of the endoscope to a target within a human body. The surgeon uses a laser system to break up the stone under illumination from an endoscope system. This situation may cause some trouble if a laser system is used to detect the stone component. The light reflected from the stone is weak, while on the other hand the illumination from the endoscopic system is strong. Therefore, it may be difficult to analyze the composition of the stone under illumination by the endoscopic system.

Fig. 26 shows an example of an endoscopic system 2600 configured to identify a target (e.g., identify a component of a stone target) using a diagnostic beam, such as a laser beam. The system 2600 may include a controller 2650, which controller 2650 may control both the endoscopic light source 2630 and the laser generator module 2640. The controller 2650 may detect a command entered by the physician through the laser system to activate the stone component detection mode. The controller 2650 may then send a command to the endoscope light source 2630 to stop illumination, or switch from a high illumination mode to a low illumination mode in which a reduced amount of illumination is projected onto the target for a period of time. During such periods of low or no illumination, the laser system 2640 may emit a laser beam toward the target and receive reflected light from the stone. The detector 2660 may use the reflected light to perform object recognition. By dimming (or turning off illumination of) the illumination of the target site in the low illumination mode, reflection of the laser beam incident on the target from the target may be enhanced, which may help improve target recognition.

Once the detector 2660 determines that target recognition is complete, the detector 2660 may send a termination command to the controller 2650. The controller 2650 may then send a command to re-illuminate the target, or switch back from low illumination to high illumination mode. In one example, when the endoscope light source 2630 receives a command to stop illumination or switch from a high illumination mode to a low illumination mode, the image processor 2670 in the endoscope system 2600 can capture a still image of the target and display the still image on a monitor of the endoscope system during the time period. Variations of the endoscope system 2600 for identifying a target have been contemplated, such as those discussed above with reference to fig. 11A-11B.

Fig. 27 shows a diagram 2700 of a laser pulse sequence with different pulse energies or power levels, which may include, for example, a first pulse train 2710 and a second pulse train 2720. The pulses in second pulse train 2720 have a higher energy or power level than the pulses in first pulse train 2710. The first pulse train 2710 and the second pulse train 2720 may be generated by respective laser sources and each of the first pulse train 2710 and the second pulse train 2720 may be emitted from the distal end of the endoscope in the form of a respective laser beam. First burst 2710 may be generated substantially constant in time, e.g., over a particular time period (e.g., controlled by a user). The second burst 2720 may be generated intermittently in time, e.g., for a particular time period during transmission of the first burst 2710. For example, second burst 2720 may be transmitted between two pulses of first burst 2710 or second burst 2720 may be transmitted between two bursts of first burst 2710. In the example shown in fig. 27, the pulses in first pulse train 2710 have a constant energy or power level, and second pulse train 2720 includes only one pulse having a higher energy or power level than first pulse train 2710. In some examples, second pulse train 2720 may include two or more pulses, each having a higher energy or power level than first pulse train 2710.

A laser pulse sequence as shown in fig. 27 can be used by a laser lithotripsy system to provide for the disruption and fragmentation of stone structures such as, for example, the kidney. As shown in fig. 27, the sequence represents time in the X direction of the graph, but is also annotated with locations "a" and "B" on a stone or other object. Thus, a sequence of laser pulses represents a spatio-temporal pattern of laser pulses having different pulse energies or power levels. In this example, location "a" is at or near the center of the stone or other target, while location "B" is at or near the periphery of the stone or other target. The laser pulses emitted between positions "a" and "B" illustrate pulses emitted when the laser fiber 140 is translated from position "a" to position "B", or pulses emitted when the laser fiber 140 is translated from position "B" to position "a", which may include, for example, the use of an actuator. The first pulse train 2710 may be selected to induce cracks in the target stone without fracturing the target stone. Thus, in fig. 27, such a first pulse train 2710 may start at position "a" to emanate towards the centre of the stone, then proceed towards position "B" towards the periphery of the stone, and then return towards position "a" located at the centre of the stone, at which time a higher energy pulse 2720 may be delivered in a first attempt to fragment the target stone. If such fragmentation by the higher energy pulse 2720 is not successful, a further first pulse train 2710 may be forwarded from a position towards the stone centre to a position "B" towards the stone periphery and then back to a position "a" at the stone centre, at which time another higher energy pulse 2720 may be forwarded in a second attempt to fragment the target stone. Further iterations are also possible. The same or different positions "B" towards the periphery of the block may be used for various iterations, wherein different positions "B" in different iterations generate a plurality of cracks along such a path from position "a" to such different peripheral positions "B". It may be preferable to use only the higher energy pulses 2720 towards the stone center, e.g., to minimize the effect of the second pulse train 2720 on nearby tissue.

In some examples, the laser pulse sequences with different pulse energies or power levels shown in fig. 27 may be used by an endoscopic system that provides hemostasis or coagulation at a target site. In an example, the first pulse train 2710 and the second pulse train 2720 can be delivered to the target site in a spatiotemporal pattern, such as alternating in time, for example, to promote an effective hemostasis or coagulation process.

Pulses having different energy or power levels, such as the first pulse train 2710 and the second pulse train 2720, may be controllably activated via a user-operable actuator, such as a button or foot pedal. For example, a user may activate transmission of a first pulse train 2710 using a first activation mode (e.g., a single press of a button or foot pedal) and activate transmission of a second pulse train 2720 using a second activation mode (e.g., two presses of a button or foot pedal). In an example, the first pulse train 2710 and the second pulse train 2720 may be controlled via separate actuators. Additionally or alternatively, the first pulse train 2710 and the second pulse train 2720 may be controllably automatically activated, for example, based on a feedback signal from a target. For example, a spectrometer may collect spectroscopy data of a target, and a feedback analyzer may analyze the spectroscopy data to identify the composition of different portions of a stone structure. Based at least on such identification, different energy pulses, such as first pulse train 2710 or second pulse train 2720, may be delivered to different portions of the target having respective identified components.

Fig. 28 generally illustrates a block diagram of an example machine 2800 on which any one or more of the techniques (e.g., methods) discussed herein may be performed. According to examples as discussed in this disclosure, portions of the present description may be applied to a computing framework of various portions of a laser treatment system.

In alternative embodiments, the machine 2800 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine 2800 may operate in the capacity of a server machine, a client machine, or both, in server-client network environments. In an example, the machine 2800 may act as a peer machine in a peer-to-peer (P2P) (or other distributed) network environment. The machine 2800 may be a Personal Computer (PC), a tablet PC, a set-top box (STB), a Personal Digital Assistant (PDA), a mobile telephone, a web application, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term "machine" can also be considered to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), or other computer cluster configurations.

As described herein, an example may include or be operated by logic or multiple components or mechanisms. A circuit group is a collection of circuits implemented in a tangible entity that includes hardware (e.g., simple circuits, gates, logic, etc.). The circuit group members may change over time and potentially with changes in hardware. The circuit group includes members that can perform specified operations individually or in combination at the time of operation. In an example, the hardware of the circuit group may be designed to perform specified operations (e.g., hardwired) unchanged. In an example, the hardware of the circuit group may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) to encode instructions specifying an operation, the variably connected physical components including a computer-readable medium that is physically modified (e.g., magnetically, electrically, movably disposed of invariant mass particles, etc.). When connecting physical components, the potential electrical properties of the hardware composition are changed, for example from an insulator to a conductor or from a conductor to an insulator. The instructions enable embedded hardware (e.g., an execution unit or a loading mechanism) to create members of a circuit group in the hardware via a variable connection to perform portions of specified operations when operating. Thus, when the device is in operation, the computer readable medium is communicatively coupled to the other components of the circuit group member. In an example, any of the physical components may be used in more than one member of more than one circuit group. For example, in operation, the execution unit may be used in a first circuit of a first circuit group at one point in time and reused by a second circuit of the first circuit group or by a third circuit of the second circuit group at a different time.

The machine (e.g., computer system) 2800 may include a hardware processor 2802 (e.g., a Central Processing Unit (CPU), a Graphics Processing Unit (GPU), a hardware processor core, or any combination thereof), a main memory 2804, and a static memory 2806, some or all of which may communicate with each other via an interconnection link (e.g., a bus) 2808. The machine 2800 may also include a display unit 2810 (e.g., a raster display, a vector display, a holographic display, etc.), an alphanumeric input device 2812 (e.g., a keyboard), and a User Interface (UI) navigation device 2814 (e.g., a mouse). In an example, the display unit 2810, the input device 2812, and the UI navigation device 2814 may be a touch screen display. The machine 2800 may additionally include a storage device (e.g., drive unit) 2816, a signal generation device 2818 (e.g., speaker), a network interface device 2820, and one or more sensors 2821 such as a Global Positioning System (GPS) sensor, compass, accelerometer, or other sensor. The machine 2800 may include an output controller 2828 such as a serial (e.g., Universal Serial Bus (USB), parallel, or other wired or wireless (e.g., Infrared (IR), Near Field Communication (NFC), etc.) connection to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.).

The storage device 2816 may include a machine-readable medium 2822 having stored thereon one or more sets of data structures or instructions 2824 (e.g., software) that implement or are utilized by any one or more of the techniques or functions described herein. The instructions 2824 may also reside, completely or at least partially, within the main memory 2804, within static memory 2806, or within the hardware processor 2802 during execution thereof by the machine 2800. In an example, one or any combination of the hardware processor 2802, the main memory 2804, the static memory 2806, or the storage device 2816 may constitute machine-readable media.

While the machine-readable medium 2822 is shown as a single medium, the term "machine-readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) configured to store the one or more instructions 2824.

The term "machine-readable medium" may include any medium that is capable of storing, encoding or carrying instructions for execution by the machine 2800 and that cause the machine 2800 to perform any one or more of the techniques of this disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. Non-limiting examples of machine readable media may include solid state memory and optical and magnetic media. In an example, a high capacity machine readable medium includes a machine readable medium having a plurality of particles with an invariant (e.g., static) mass. Thus, a mass machine readable medium is not a transitory propagating signal. Specific examples of the mass machine-readable medium may include: non-volatile memories such as semiconductor memory devices (e.g., Electrically Programmable Read Only Memory (EPROM), electrically erasable programmable read only memory (EPSOM)) and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

The instructions 2824 may also be transmitted or received over a communication network 2826 using a transmission medium via the network interface device 2820 using any one of a number of transmission protocols (e.g., frame relay, Internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks may include a Local Area Network (LAN), a Wide Area Network (WAN), a packet data network (e.g., the internet), a mobile telephone network (e.g., a cellular network), a Plain Old Telephone (POTS) network, and a wireless data network (e.g., referred to as a "wireless data network")

Of the Institute of Electrical and Electronics Engineers (IEEE)802.11 family of standards, referred to as

IEEE 802.16 family of standards), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, and the like. In an example, the network interface device 2820 may include one or more physical jacks (e.g., ethernet, coaxial, or telephone jacks) or one or more antennas for connecting to the communications network 2826. In an example, the network interface device 2820 may include multiple antennas to wirelessly communicate using at least one of a single-input multiple-output (SIMO) technique, a multiple-input multiple-output (MIMO) technique, or a multiple-input single-output (MISO) technique. The term "transmission medium" shall be taken to include any intangible medium that is capable of storing, encoding, or carrying instructions for execution by the machine 2800, and the term "transmission medium" shall be taken to include digital or analog communications signals or other intangible medium to facilitate communication of such software.

Additional description

The foregoing detailed description includes references to the accompanying drawings, which form a part hereof. By way of illustration, the drawings show specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples. Such examples may include elements in addition to those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the inventors also contemplate examples using any combination or permutation of the elements (or one or more aspects of the elements) shown or described with respect to a particular example (or one or more aspects of a particular example) or with respect to other examples (or one or more aspects of other examples) shown or described herein.

In this disclosure, the terms "a" or "an" are used to include one or more than one, regardless of any other instances or usages of "at least one" or "one or more," as is common in patent publications. In this disclosure, unless otherwise indicated, the term "or" is used to refer to a non-exclusive or, such that "a or B" includes "a but not B," B but not a, "and" a and B. In this disclosure, the terms "including" and "in … … are used as plain-english equivalents of the respective terms" comprising "and" wherein ". Furthermore, in the following claims, the terms "comprises" and "comprising" are open-ended, that is, a system, apparatus, article, composition, formulation, or process that comprises elements in addition to those elements listed after such term in a claim is still considered to be within the scope of that claim. Furthermore, in the appended claims, the terms "first," "second," and "third," etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.

The above description is intended to be illustrative, and not restrictive. For example, the examples described above (or one or more aspects of an example) may be used in combination with each other. Other embodiments may be used, for example, by one of ordinary skill in the art in view of the above description. The abstract is provided to comply with 37c.f.r. § 1.72(b), to enable the reader to quickly ascertain the nature of the technical disclosure. The abstract was submitted and understood: the abstract is not intended to be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing detailed description, various features may be combined together to organize the disclosure. This should not be interpreted to mean: the features of the disclosure that are not claimed are essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the detailed description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments may be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

Claims

1. A laser feedback control system coupled to a first laser system configured to deliver laser energy toward a target tissue, the laser feedback control system comprising:

a feedback analyzer for receiving a signal from a target tissue using a spectroscopic sensor, the signal comprising a first signal indicative of one or more spectroscopic properties of the target tissue; and

a laser controller in operable communication with each of the feedback analyzer and the first laser system, the laser controller configured to:

receiving the first signal from the feedback analyzer;

determining whether the first signal is substantially equal to a first preset; and is

Sending a first control signal to the first laser system to change from a first state of the first laser system to a second state of the first laser system if the first signal satisfies a first preset.

2. The laser feedback control system of claim 1, wherein the laser controller is further configured to receive a second signal from the feedback analyzer, the second signal being different from the first signal.

3. The laser feedback control system of claim 2, wherein the laser controller is further configured to: sending a second control signal to the first laser system to change from the second state of the first laser system to the first state of the first laser system if the second signal is substantially equal to a second preset.

4. A laser feedback control system according to any of claims 2 to 3, wherein the laser feedback control system is configured to be connectable to a second laser system different from the first laser system.

5. A laser feedback control system according to claim 4, wherein the laser controller is configured to independently control the first and second laser systems.

6. The laser feedback control system of claim 5, wherein the laser controller is configured to send a third control signal to the second laser system to change from a first state of the second laser system to a second state of the second laser system if the second signal is substantially equal to a second preset.

7. The laser feedback control system of claim 6, wherein the laser controller is configured to send a fourth control signal to the second laser system to change from the second state of the second laser system to the first state of the second laser system if the laser controller determines that the first signal is substantially equal to the first preset.

8. The laser feedback control system of claim 7, wherein, in the event that the laser controller determines that the first signal satisfies the first preset, the laser controller is configured to:

sending the first control signal to the first laser system to change the first laser system from a first state of the first laser system to a second state of the first laser system; and

sending the fourth control signal to the second laser system to change the second laser system from the second state of the second laser system to the first state of the second laser system.

9. The laser feedback control system of claim 8, wherein, in the event that the laser controller determines that the second signal satisfies the second preset, the laser controller is configured to:

sending the second control signal to the first laser system to change the first laser system from the second state of the first laser system to the first state of the first laser system; and

sending the third control signal to the second laser system to change the second laser system from the first state of the second laser system to the second state of the second laser system.

10. The laser feedback control system of any of claims 1 to 9, wherein the spectroscopy sensor comprises at least one of:

an imaging camera device;

a Fourier Transform Infrared (FTIR) spectrometer;

a Raman spectrometer;

a UV-VIS reflectance spectrometer; or

A fluorescence spectrometer.

11. The laser feedback control system of any of claims 1 to 10, further comprising a signal detection fiber operably coupled to the spectroscopy sensor, the signal detection fiber configured to transmit the first signal from the target tissue to the spectroscopy sensor.

12. The laser feedback control system according to any of claims 1 to 11, wherein the spectroscopy sensor is in operable communication with a first optical fiber of the first laser system, the spectroscopy sensor being configured to detect the first signal via the first optical fiber of the first laser system.

13. A laser therapy system comprising:

a first laser system, comprising:

a first laser source, and

a first optical fiber operably coupled to the first laser source, the first optical fiber configured to transmit energy from the first laser source to a target tissue; and

a laser feedback control system coupled to the first laser system, the laser feedback control system comprising:

a feedback analyzer for receiving a signal from the target tissue, the signal comprising a first signal indicative of one or more spectroscopic characteristics of the target tissue; and

a laser controller in operative communication with each of the feedback analyzer and the first laser system, the laser controller configured to receive the first signal from the feedback analyzer to determine whether the first signal is substantially equal to a first preset, and send a first control signal to the first laser system to change from a first state of the first laser system to a second state of the first laser system.

14. The laser therapy system according to claim 13, further comprising a second laser system including a second laser source in operable communication with the first optical fiber.

15. The laser therapy system according to claim 14, wherein the first laser source is configured to produce a first laser output within a first wavelength range and the second laser source is configured to produce a second laser output within a second wavelength range different from the first wavelength range.

16. The laser therapy system according to claim 15, wherein the first wavelength range corresponds to at least a portion of an absorption spectrum of the target tissue and the second wavelength range corresponds to at least a portion of an absorption spectrum of carbonized tissue.

17. The laser therapy system according to any one of claims 14 to 16, wherein the second laser system is controllable by the laser controller such that upon receiving a control signal from the laser controller the second laser system changes from a first state of the second laser system to a second state of the second laser system or from the second state of the second laser system to the first state of the second laser system.

18. The laser therapy system according to any one of claims 14 to 17, wherein the first state of each of the first and second laser systems corresponds to the generation of a first laser output by the first laser source and a second laser output by the second laser source, respectively.

19. The laser therapy system according to any one of claims 14 to 18, wherein the second state of each of the first and second laser systems corresponds to a state in which the first and second laser sources each produce no laser output.

20. A method of controlling a laser therapy system including a first laser system, the method comprising:

receiving, using a feedback analyzer, a signal from a target tissue, the signal comprising a first signal indicative of one or more spectroscopic properties of the target tissue;

determining, using a laser controller, whether the first signal is substantially equal to a first preset; and

sending a first control signal to the first laser system to change from a first state of the first laser system to a second state of the first laser system if the first signal is substantially equal to the first preset.

21. The method of claim 20, wherein the first signal indicates that the target tissue was carbonized by absorbing first laser output from the first laser system.

22. The method of claim 21, wherein the first state of the first laser system corresponds to a state when the first laser system is producing the first laser output, and the second state of the first laser system corresponds to a state when the first laser system is not producing the first laser output.

23. The method of any one of claims 20 to 22, wherein the signal received by the feedback analyzer comprises a second signal different from the first signal.